What Diabetic Supplies are Covered by Medicaid – Overview
Medicare Part B (Medical Insurance) and Medicare Part D (Drug Coverage) cover some of the diabetic supplies and services.
Usually, Medicare Part B covers all services that affect people suffering from diabetes. This part of Medicare also covers several preventive services for those who are at risk of developing diabetes.
To avail of these services, you must have an active Medicare Part B insurance policy.
Medicare Part D covers the expenses of diabetes supplies used to inject or inhale insulin. You must be enrolled in a Medicare drug plan to receive diabetes supplies under Medicare Part D.
Diabetes Supplies are Covered by Medicare Part B
Medicare Part B covers certain supplies if you have diabetes, this includes:
Blood Sugar Self-Testing Equipment and Supplies
Medicare Part B covers blood sugar level self-testing equipment and supplies under durable medical equipment. This provision is available even if you do not need to use insulin.
Some commonly used self-testing equipment for diabetes that is covered under Medicare Part B include:
#1. Blood sugar monitors
#2. Blood sugar test strips
#3. Lancet devices and lancets
#4. Glucose control solutions
Medicare Part B covers the cost of the above-listed equipment however, the extent of coverage may vary.
For instance, if you use insulin, then you may be able to receive up to 300 test strips and 300 lancets once every 3 months. If you don’t use insulin, then you are eligible to get 100 test strips and 100 lancets every 3 months.
If your physician considers it medically necessary, and if other documents and qualification criteria are met, then Medicare allows you to receive additional test strips and lancets.
The term “medically necessary” means that you need the supplies or services for the diagnosis or treatment of your medical condition if they meet the standards of medical practice.
If you meet certain criteria, then Medicare will also cover therapeutic continuous glucose monitors and related supplies approved for you instead of conventional blood sugar monitors.
This helps to make diabetes treatment decisions, such as changes in diet or insulin dosage.
Medicare will only provide cover for blood sugar self-testing equipment and supplies when you get a prescription from your doctor. This prescription should include:
#1. If you have diabetes
#2. The kind of blood sugar monitor you require and the reason you require it
#3. If you use insulin
#4. Frequency of testing your blood sugar
#5. The number of strips and lancets you need in a month
#6. To learn specific criteria for this, you can visit the official website at https://www.medicare.gov/coverage.
Getting Diabetes Supplies and Equipment under Medicare
You can order and pick up your diabetes supplies and equipment at the local pharmacy. Or, you can order your diabetes supplies or equipment from a medical equipment supplier.
Usually, your medical supplier is any person, company or agency that sells/provides you a medical item or service, except in cases where you are an inpatient in a skilled nursing facility or hospital.
For such an instance, you will require a prescription from your physician to place the order, as your physician will not be able to order it for you.
You can only get diabetes supplies and equipment from a pharmacy or a supplier that is part of the Medicare network.
Make sure to ask for refills for your supplies and get a new prescription from your physician for new strips and lancets every 12 months.
When you order the required diabetes testing equipment you will only need to pay your coinsurance amount when you get the supplies from a supplier or pharmacy.
Getting Insulin Pumps under Medicare
Medicare Part B often covers the cost of external insulin pumps (those that are worn outside the body), which includes insulin used with the pump for some people who meet certain conditions.
Certain insulin pumps are considered medically necessary durable equipment, hence covered by Medicare.
If you need an insulin pump, then you will need a prescription from your physician.
In Original Medicare, you have to pay 20% of the total cost after the yearly Part B deductible. Medicare pays 80% of the cost of insulin and insulin pump.
To learn specific details for getting insulin pumps under Medicare, you can visit the official website at https://www.medicare.gov/coverage.
Getting Therapeutic Inserts and Shoes
If you have Medicare Part B and suffer from diabetes with certain conditions, then Medicare will cover the cost of therapeutic shoes, if you need them. Medicare Part B covers the following types of shoes:
#1. One pair of depth-inlay shoes and 3 pairs of inserts
#2. One pair of custom-molded shoes, including inserts, if you don’t wear depth-inlay shoes owing to a foot deformity and 2 additional pairs of inserts.
To get therapeutic shoes, your physician must clarify the following three conditions:
#1. You have diabetes
#2. You have a foot deformity in one or both feet
#3. You are being treated under a comprehensive diabetes care plan and require therapeutic shoes and/or inserts because of diabetes
You can easily get various types of diabetes self-testing equipment and supplies, like insulin, insulin pumps and therapeutic shoes and inserts under Medicare Part B.
Make sure to check with your physician so they can guide you to receive the benefits under your medical insurance.