Medicare Diabeties Coverage

Large Print Edition

Centers for Medicare & Medicaid Services

Medicare Coverage

of Diabetes Supplies,

Services, & Prevention

Programs

This ocial government booklet has important

information about:

•

WhatMedicarecovers

•

Helpfultipstokeepyouhealthy

•

Wheretogetmoreinformation

TheinformationinthisbookletdescribestheMedicare

Programatthetimethisbookletwasprinted.Changes

mayoccurafterprinting.VisitMedicare.gov,orcall

1800633-4227togetthemostcurrentinformation.TTY

userscancall1877486-2048.

“MedicareCoverageofDiabetesSupplies,Services,&

PreventionPrograms”isn’talegaldocument.Ocial

MedicareProgramlegalguidanceiscontainedinthe

relevantstatutes,regulations,andrulings.

Thiseducationalpublicationwasproducedand

disseminatedatU.S.taxpayerexpense.

Table of Contents

Introduction ___ Page 5

Section 1: Medicare Coverage for Diabetes

at-a-Glance ___ Page 9

Section 2: Medicare Part B Coverage for Diabetes

Supplies ___ Page 19

Bloodsugarself-testingequipment&supplies___

Page20

Insulinpumps___Page25

Therapeuticshoesorinserts___Page25

Replacinglostordamageddurablemedicalequipment

orsuppliesinadisasteroremergency___Page27

Section 3: Medicare Drug Coverage for Diabetes ___

Page 28

Insulin___Page29

Anti-diabeticdrugs___Page29

Diabetessupplies___Page30

Formoreinformation___Page31

—

Table of Contents

Section 4: Medicare Coverage for Diabetes Screenings

& Services ___ Page 32

Diabetesscreenings___Page33

MedicareDiabetesPreventionProgram___Page34

Diabetesself-managementtraining___Page35

Medicalnutritiontherapyservices___Page40

Footexams&treatment___Page41

HemoglobinA1ctests___Page41

Glaucomatests___Page42

Flu&pneumococcalshots___Page42

“WelcometoMedicare”preventivevisit___Page43

Yearly“Wellness”visit___Page43

Supplies&servicesthatMedicaredoesn’t

cover___Page44

Section 5: Helpful Tips & Resources ___ Page 46

Tipstohelpcontroldiabetes___Page47

Phonenumbers&websites___Page49

Introduction

ThisbookletexplainsMedicarecoverageofdiabetes

suppliesandservicesinOriginalMedicareandwith

Medicaredrugcoverage(PartD).

OriginalMedicareisfee-for-servicecoverage.The

governmentusuallypaysyourhealthcareproviders

directlyforyourMedicarePartA(HospitalInsurance)

and/orPartB(MedicalInsurance)benets.

IfyouhaveotherinsurancethatsupplementsOriginal

Medicare,likeaMedicareSupplementInsurance

(Medigap)policy,itmaypaysomeofthecostsforsome

servicesdescribedinthisbooklet.Contactyourplan’s

benetsadministratorformoreinformation.

IfyouhaveaMedicareAdvantagePlanorotherhealth

planbyaMedicare-approvedprivatecompany(likea

MedicareCostPlan,Demonstration/PilotProgram,or

ProgramofAll-inclusiveCarefortheElderly(PACE)),your

planmustgiveyouatleastthesamecoverageasOriginal

Medicare,butitmayhavedierentrules.Yourcosts,

rights,protections,andchoicesforwhereyougetyour

caremightbedierentifyou’reinoneoftheseplans.You

mightalsogetextrabenets.Readyourplanmaterials,or

callyourbenetsadministratorformoreinformation.

—

Introduction

It will be helpful to understand these terms as

you read this booklet:

Coinsurance:Anamountyoumayberequiredtopay

asyourshareofthecostforservicesafteryoupayany

deductibles.Coinsuranceisusuallyapercentage(for

example,20%).

Copayment:Anamountyoumayberequiredtopayas

yourshareofthecostforamedicalserviceorsupply,like

adoctor’svisit,hospitaloutpatientvisit,orprescription

drug.Acopaymentisusuallyasetamount,ratherthana

percentage.Forexample,youmightpay$10or$20fora

doctor’svisitorprescription.

Deductible:Theamountyoumustpayforhealthcare

orprescriptionsbeforeOriginalMedicare,yourMedicare

AdvantagePlan,yourMedicare,oryourotherinsurance

beginstopay.

Durable medical equipment:Certainmedical

equipment,likeawalker,wheelchair,orhospitalbed,

that’sorderedbyyourdoctorforuseinthehome.

Medicare-approved amount:InOriginalMedicare,thisis

theamountadoctororsupplierthatacceptsassignment

canbepaid.Assignmentisanagreementbyyourdoctor,

provider,orsuppliertobepaiddirectlybyMedicare,to

acceptthepaymentamountMedicareapprovesforthe

—

Introduction

service,andnottobillyouforanymorethantheMedicare

deductibleandcoinsurance.Itmaybelessthantheactual

amountadoctororsuppliercharges.Medicarepayspart

ofthisamountandyou’reresponsibleforthedierence.

•

EndofPage

Notes



Section 1:

Medicare Coverage

for Diabetes

at-a-Glance

Theinformationonpages10–17providesaquick

overviewofsomeofthediabetesservicesandsupplies

coveredbyMedicarePartB(MedicalInsurance)and

Medicaredrugcoverage(PartD).

Generally,PartBcoversservicesthatmayaectpeople

withdiabetes.PartBalsocoverssomepreventive

servicesforpeoplewhoareatriskfordiabetes.Youmust

havePartBtogetservicesandsuppliesitcovers.

PartDcoversdiabetessuppliesusedtoinjectorinhale

insulin.YoumustbeenrolledinaMedicaredrugplanto

getsuppliesPartDcovers.

—

Section 1: Medicare Coverage for Diabetes At-a Glance

Anti-diabetic drugs

Seepage29–30.

What Medicare covers

PartDcoversanti-diabeticdrugstomaintainbloodsugar

(glucose).

What you pay

Coinsuranceorcopayment

PartDdeductiblemayalsoapply

Diabetes screenings

Seepage33.

What Medicare covers

PartBcoversthesescreeningsifyourdoctordetermines

you’reatriskfordiabetes.Youmaybeeligibleforupto2

diabetesscreeningtestseachyear.

What you pay

Nocoinsurance,copayment,orPartBdeductiblefor

screenings

Generally,20%oftheMedicare-approvedamountafter

theyearlyPartBdeductibleforthedoctor’svisit

—

Section 1: Medicare Coverage for Diabetes At-a Glance

Medicare Diabetes Prevention Program

Seepages34–35.

What Medicare covers

PartBcoversaonce-per-lifetimehealthbehaviorchange

programtohelpyoupreventdiabetes.

What you pay

Nothingfortheseservicesifyou’reeligible

Diabetes self- management training

Seepages35-40.

What Medicare covers

PartBcoversdiabetesself-managementtraining

servicesforpeoplediagnosedwithdiabetesoratriskfor

complicationsfromdiabetes.ForMedicaretocoverthese

services,yourdoctororotherhealthcareprovidermust

orderit,andanaccreditedindividualorprogrammust

providetheservices.

What you pay

20%oftheMedicare-approvedamountaftertheyearly

PartBdeductible

—

Section 1: Medicare Coverage for Diabetes At-a Glance

Diabetes equipment & supplies

Seepage20–24.

What Medicare covers

PartBcovershomebloodsugar(glucose)monitorsand

suppliesyouusewiththeequipment,includingblood

sugarteststrips,lancetdevices,andlancets.There

maybelimitsonhowmuchorhowoftenyougetthese

supplies.

What you pay

20%oftheMedicare-approvedamountaftertheyearly

PartBdeductible

Diabetes supplies

Seepage30.

What Medicare covers

PartDcoverscertainmedicalsuppliestoadminister

insulin(likesyringes,needles,alcoholswabs,gauze,and

inhaledinsulindevices).

What you pay

Coinsuranceorcopayment

PartDdeductiblemayalsoapply

—

Section 1: Medicare Coverage for Diabetes At-a Glance

Flu & pneumococcal shots

Seepage42.

What Medicare covers

•

Flu shot—PartBcoversthisshotonceauseasonin

thefallorwintertohelppreventinuenzaoruvirus.

•

Pneumococcal shot—PartBcoversthisshottohelp

preventpneumococcalinfections(likecertaintypesof

pneumonia).

What you pay

Nocoinsurance,copayment,orPartBdeductibleifyour

doctororhealthcareprovideracceptsassignment

Foot exams & treatment

Seepage41.

What Medicare covers

PartBcoversafootexamevery6monthsifyouhave

diabeticperipheralneuropathyandlossofprotective

sensation,aslongasyouhaven’tseenafootcare

professionalforanotherreasonbetweenvisits.

What you pay

20%oftheMedicareapprovedamountaftertheyearly

PartBdeductible

—

Section 1: Medicare Coverage for Diabetes At-a Glance

Glaucoma tests

Seepage42.

What Medicare covers

PartBcoversthistestonceevery12monthsifyou’reat

highriskforglaucoma.Adoctorlegallyauthorizedbythe

statemustdothetest.

What you pay

20%oftheMedicare-approvedamountaftertheyearly

PartBdeductible

Insulin

Seepage29.

What Medicare covers

PartDcoversinsulinthatisn’tadministeredwithaninsulin

pump.

What you pay

Coinsuranceorcopayment

PartDdeductiblemayalsoapply

—

Section 1: Medicare Coverage for Diabetes At-a Glance

Insulin pumps

Seepage25.

What Medicare covers

PartBcoversexternaldurableinsulinpumpsandthe

insulinthepumpusesunderdurablemedicalequipmentif

youmeetcertainconditions.

What you pay

20%oftheMedicare-approvedamountaftertheyearly

PartBdeductible

Medical nutrition therapy services

Seepages40-41.

What Medicare covers

PartBmaycovermedicalnutritiontherapyandcertain

relatedservicesifyouhavediabetesorkidneydisease.A

doctormustreferyoufortheseservices.

What you pay

Nocopayment,coinsurance,orPartBdeductibleifyour

doctororhealthcareprovideracceptsassignment

—

Section 1: Medicare Coverage for Diabetes At-a Glance

Therapeutic shoes or inserts

Seepages25 -27. 

What Medicare covers

PartBcoverstherapeuticshoesorinsertsifyouhave

diabetesandseverediabeticfootdisease.

What you pay

20%oftheMedicare-approvedamountaftertheyearly

PartBdeductible

“Welcome to Medicare” preventive visit

Seepage43.

What Medicare covers

Withintherst12monthsyouhavePartB,Medicare

coversaone-timereviewofyourhealth,andeducation

andcounselingaboutpreventiveservices,including

certainscreenings,shots,andreferralsforothercare,if

needed.

What you pay

Nocopayment,coinsurance,orPartBdeductibleifyour

doctororhealthcareprovideracceptsassignment

—

Section 1: Medicare Coverage for Diabetes At-a Glance

Yearly “Wellness” visit

Seepage43.

What Medicare covers

Ifyou’vealreadyhadPartBforlongerthan12months,

youcangetayearly“Wellness”visittodeveloporupdate

apersonalizedpreventionplanbasedonyourcurrent

healthandriskfactors.

What you pay

Nocopayment,coinsuranceorPartBdeductibleifyour

doctororhealthcareprovideracceptsassignment.

Ifyouhada“WelcometoMedicare”visit,you’llhave

towait12monthsbeforeyoucangetyourrstyearly

“Wellness”visit.

Notes



Section 2:

Medicare Part B

Coverage for

Diabetes Supplies

ThissectionprovidesinformationaboutPartB(Medical

Insurance)anditscoverageofdiabetessupplies.

Medicarecoverscertainsuppliesifyouhavediabetesand

PartB,including:

•

Blood sugar self-testing equipment & supplies.

Seepages20-24.

•

Insulin pumps.Seepage25.

•

Therapeutic shoes or inserts.Seepages25 -27.

•

EndofPage

—

Section 2: Medicare Part B Coverage for Diabetes Supplies

Blood sugar self-testing equipment & supplies

PartBcoversbloodsugar(alsocalledbloodglucose)

self-testingequipmentandsuppliesasdurablemedical

equipment.

Self-testingsuppliesinclude:

•

Bloodsugarmonitors

•

Bloodsugarteststrips

•

Lancetdevicesandlancets

•

Glucosecontrolsolutions forcheckingtheaccuracyof

testingequipmentandteststrips

However,theamountofsuppliesthatPartBcoversvaries.

•

Ifyouuseinsulin,youmaybeabletogetupto300

teststripsand300lancetsevery3months.

•

Ifyoudon’tuseinsulin,youmaybeabletoget100test

stripsand100lancetsevery3months.

Ifyourdoctorsaysit’smedicallynecessary,andyoumeet

otherqualicationsanddocumentationrequirements,

Medicare will allow you to get additional test strips

and lancets.“Medicallynecessary”meansthatyou

needservicesorsuppliesforthediagnosisortreatment

ofyourmedicalconditionandmeetacceptedstandards

ofmedicalpractice.Youmayneedtokeeparecordthat

showshowoftenyou’reactuallytestingyourself.

—

Section 2: Medicare Part B Coverage for Diabetes Supplies

Ifyoumeetcertaincriteria,Medicarealsocovers

continuousglucosemonitorsandrelatedsupplies

approvedforuseinplaceof,oralongwith,bloodsugar

monitorsformakingdiabetestreatmentdecisions(like

changesindietandinsulindosage).Ifyouuseinsulin

andrequirefrequentadjustmentstoyourinsulinregimen/

dosage,Medicaremaycoveracontinuousglucose

monitorifyourdoctordeterminesthatyoumeetallofthe

requirementsforMedicarecoverage,includingtheneed

tofrequentlycheckyourbloodsugar(4ormoretimesa

day)andtheneedtoeitheruseaninsulinpumporget3

ormoreinsulininjectionsperday.Youmustalsomake

routinein-personvisitswithyourdoctor.

Ifyouhavequestionsaboutdiabetessupplies,visit

Medicare.gov/coverage.Youcanalsocall

1800633-4227.TTYuserscancall1877486-2048.

—

Section 2: Medicare Part B Coverage for Diabetes Supplies

What do I need from my doctor to get these

covered supplies?

Medicarewillonlycoveryourbloodsugarself-testing

equipmentandsuppliesifyougetaprescriptionfromyour

doctor.Theprescriptionshouldinclude:

•

Whetheryouhavediabetes.

•

Whatkindofbloodsugarmonitoryouneedandwhy

youneedit.(Ifyouneedaspecialmonitorbecauseof

visionproblems,yourdoctormustexplainthat.)

•

Whetheryouuseinsulin.

•

Howoftenyoushouldtestyourbloodsugar.

•

Howmanyteststripsandlancetsyouneedforone

month.

Keep in mind:

•

Youmustaskforrellsforyoursupplies.

•

Youneedanewprescriptionfromyourdoctorforyour

lancetsandteststripsevery12months.

Where can I get these supplies?

•

Youcanorderandpickupyoursuppliesatyour

pharmacy.

•

Youcanorderyoursuppliesfromamedicalequipment

supplier.Generally,a“supplier”isanycompany,

person,oragencythatgivesyouamedicalitemor

service,exceptwhenyou’reaninpatientinahospital

—

Section 2: Medicare Part B Coverage for Diabetes Supplies

orskillednursingfacility.Ifyougetyoursuppliesthis

way,youmustplacetheorderyourself.You’llneeda

prescriptionfromyourdoctortoplaceyourorder,but

yourdoctorcan’torderthesuppliesforyou.

What supplier or pharmacy should I use?

Youmustgetsuppliesfromapharmacyorsupplierthat’s

enrolledinMedicare.Ifyougotoapharmacyorsupplier

thatisn’tenrolledinMedicare,Medicarewon’tpay.You’ll

have to pay the entire bill for any supplies from non-

enrolled pharmacies or non-enrolled suppliers.

Beforeyougetasupplyit’simportanttoaskthesupplier

orpharmacythesequestions:

•

AreyouenrolledinMedicare?

•

Doyouacceptassignment?

Iftheanswertoeitherofthese2questionsis“no,”you

shouldcallanothersupplierorpharmacyinyourareawho

answers“yes”tobesureMedicarecoversyourpurchase

andtosaveyoumoney.

Tondasupplierthat’senrolledinMedicare,visit

Medicare.gov/supplier.Or,call1800633-4227.TTY

userscancall1877486-2048.

Note: Medicarewon’tpayforanysuppliesyoudidn’task

for,orforanysuppliesthatweresenttoyouautomatically

fromsuppliers,includingbloodsugarmonitors,test

—

Section 2: Medicare Part B Coverage for Diabetes Supplies

strips,andlancets.Ifyou’regettingsuppliessenttoyou

automatically,aregettingmisleadingadvertisements,or

suspectfraudrelatedtoyourdiabetessupplies,call

1800633-4227.TTYuserscancall1877486-2048.

Who’s responsible for submitting claims?

AllMedicare-enrolledpharmaciesandsuppliersmust

submitclaimsforbloodsugar(glucose)monitors,test

strips,andotheritemscoveredunderdurablemedical

equipment.Youcan’tsubmitaclaimforabloodsugar

monitororteststripsyourself.

What do I have to pay?

Youpaynomorethanyourcoinsuranceamountwhen

yougetyoursuppliesfromapharmacyorsupplierthat

acceptsassignment.Ifyourpharmacyorsupplierdoesn’t

acceptassignment,chargesmaybehigher,andyoumay

paymore.Youmayalsohavetopaytheentirechargeat

thetimeofservice,andwaitforMedicaretosendyouits

shareofthecost.

—

Section 2: Medicare Part B Coverage for Diabetes Supplies

Insulin pumps

PartBmaycoverinsulinpumpswornoutsidethebody

(external),includingtheinsulinusedwiththepumpfor

somepeoplewithPartBwhohavediabetesandwho

meetcertainconditions.Certaininsulinpumpsare

considereddurablemedicalequipment.

How do I get an insulin pump?

Ifyouneedaninsulinpump,yourdoctorwillprescribeit

foryou.

Note:InOriginalMedicare,youpay20%oftheMedicare-

approvedamountaftertheyearlyPartBdeductible.

Medicarewillpay80%ofthecostoftheinsulinandthe

insulinpump.

Therapeutic shoes or inserts

IfyouhavePartB,havediabetes,andmeetcertain

conditions(seepage26),Medicarewillcovertherapeutic

shoesifyouneedthem.

ThetypesofshoesPartBcoverseachyearinclude one

ofthese:

•

Onepairofdepth-inlayshoesand3pairsofinserts

•

Onepairofcustom-moldedshoes(includinginserts)

ifyoucan’tweardepth-inlayshoesbecauseofafoot

deformity,and2additionalpairsofinserts

—

Section 2: Medicare Part B Coverage for Diabetes Supplies

Note: Incertaincases,Medicaremayalsocoverseparate

insertsorshoemodicationsinsteadofinserts.

How do I get therapeutic shoes?

ForMedicaretopayforyourtherapeuticshoes,thedoctor

treatingyourdiabetesmustcertifythatyoumeetthese3

conditions:

1. Youhavediabetes.

2. Youhaveatleastoneoftheseconditionsinoneor

bothfeet:

•

Partialorcompletefootamputation

•

Pastfootulcers

•

Callusesthatcouldleadtofootulcers

•

Nervedamagebecauseofdiabeteswithsignsof

problemswithcalluses

•

Poorcirculation

•

Adeformedfoot

3. You’rebeingtreatedunderacomprehensivediabetes

careplanandneedtherapeuticshoesand/orinserts

becauseofdiabetes.

Medicarealsorequires:

•

Apodiatristorotherqualiedhealthcareprovider

prescribestheshoes.

—

Section 2: Medicare Part B Coverage for Diabetes Supplies

•

Adoctororotherqualiedindividual,likea

pedorthist,orthotist,orprosthetist,tsand

providestheshoes.

Replacing lost or damaged durable medical

equipment or supplies in a disaster or emergency

IfOriginalMedicarealreadypaidfordurablemedical

equipment(likeawheelchairorwalker)orsupplies(like

diabeticsupplies)damagedorlostduetoanemergency

ordisaster:

•

Incertaincases,Medicarewillcoverthecosttorepair

orreplaceyourequipmentorsupplies.

•

Generally,Medicarewillalsocoverthecostofrentals

foritems(likewheelchairs)duringthetimeyour

equipmentisbeingrepaired.

Forinformationabouthowtoreplaceyourequipmentor

supplies,visitMedicare.gov,orcall1800633-4227.TTY

userscancall1877486-2048.

Section 3:Medicare

Drug Coverage for

Diabetes

ThissectionprovidesinformationaboutMedicaredrug

coverage(PartD)forpeoplewithMedicarewhohaveor

areatriskfordiabetes.TogetMedicaredrugcoverage,

youmustjoinaMedicaredrugplan.Medicaredrugplans

coverthesediabetesdrugsandsupplies:

•

Insulin

•

Anti-diabeticdrugs

•

Certaindiabetessupplies

Part D Senior Savings Model

YoumaybeabletogetMedicaredrugcoveragethat

givessupplementalbenetsspecicallyforinsulin.The

PartDSeniorSavingsModelisavailabletoallpeoplewith

Medicare.Plansthatparticipateinthismodelwilloer

coveragechoicesthatincludemultipletypesofinsulin

atamaximumcopaymentof$35foramonth’ssupply.

(The$35maximumcopaymentdoesn’tapplyduringthe

catastrophicphaseofMedicaredrugcoverage.)

—

Section 3: Medicare Drug Coverage for Diabetes

Note:The$35copaymentforinsulindoesn’tapplyifyou

alreadygetExtraHelp.IfyougetfullExtraHelp,your

copaymentforinsulinislowerthan$35.Ifyougetpartial

ExtraHelpin2023,whatyoupaymaybehigherorlower

thanthe$35copayment.

Insulin

Medicaredrugplanscoverinjectableinsulinnotusedwith

aninsulininfusionpump.Someplansalsocoverinhaled

insulin.

Anti-diabetic drugs

Bloodsugar(glucose)thatisn’tcontrolledbyinsulinis

maintainedbyanti-diabeticdrugs.Althoughnotallof

thesedrugswillbeoneveryplan’sdruglist,Medicare

drugplanscancoveranti-diabeticdrugslike:

•

AlphaglucosidaseinhibitorslikePrecose®(acarbose)

andGlyset®(miglitol)

•

BiguanideslikeGlucophage®(metformin)

•

Glucagon-likepeptide1(GLP-1)receptoragonists

likeAdlyxin®(lixisenatide),Byetta®,Bydureon®

(exenatide),Ozempic®(semaglutide),Tanzeum®

(albiglutide),Trulicity®(dulaglutide)andVictoza®

(liraglutide).

—

Section 3: Medicare Drug Coverage for Diabetes

•

MeglitinideslikeStarlix®(nateglinide)andPrandin®

(repaglinide)

•

Sodium-GlucoseCo-Transporter2Inhibitors(SGLT-

2inhibitors)likeFarxiga®(dapagliozin),Invokana®

(canagliozin),andJardiance®(empagliozin)

•

SulfonylureaslikeGlucotrol®(glipizide)andGlynase®

(glyburide)

•

ThiazolidinedioneslikeActos®(pioglitazone)and

Avandia®(rosiglitazone)

Diabetes supplies

Suppliesusedtoinjectorinhaleinsulinarecoveredif

youhaveMedicaredrugcoverageanddiabetes.These

medicalsuppliesinclude:

•

Alcoholswabs

•

Gauze

•

Inhaledinsulindevices

•

Inhaledinsulindeviceswithorwithoutincludedinsulin

•

Insulinpenswithorwithoutincludedinsulin

•

Needles

•

Syringes

—

Section 3: Medicare Drug Coverage for Diabetes

For more information

TogetmoreinformationaboutMedicaredrugcoverage:

•

VisitMedicare.gov/drug-coverage-part-d

•

Call1800633-4227.TTYuserscancall

1877486-2048.

•

CallyourStateHealthInsuranceAssistanceProgram

(SHIP)forfreehealthinsurancecounseling.Togettheir

phonenumber,visitshiphelp.org,orcall

1800633-4227.

•

EndofPage

Section 4:

Medicare Coverage

for Diabetes

Screenings &

Services

PartBcoverscertainservices,screenings,andtrainings

tohelpyouprevent,detect,andtreatdiabetes.

Ingeneral,yourdoctormustwriteanorderorreferralfor

youtogettheseservices,including:

•

Diabetes screenings.Seepage33-34.

•

Medicare Diabetes Prevention Program. Seepages

34-35.

•

Diabetes self-management training. Seepages

35-40.

•

Medical nutrition therapy services.Seepages

40-41.

•

Hemoglobin A1c tests.Seepage41.

YoucangetsomeMedicare-coveredserviceswithouta

writtenorderorreferral.Seepages42-43.

—

Section 4: Medicare Coverage for Diabetes Services

Diabetes screenings

PartBpaysfordiabetesscreeningtestsifyou’reatriskfor

diabetes.Thesetestshelptodetectdiabetesearly.You

maybeatriskfordiabetesifyouhave:

•

Highbloodpressure

•

Dyslipidemia(historyofabnormalcholesteroland

triglyceridelevels)

•

Obesity(denedasabodymassindex(BMI)≥30)

•

Impairedglucose(bloodsugar)tolerance

•

Highfastingglucose(bloodsugar)

Youalsomaybeatriskifyouhave2ormoreoftheserisk

factors:

•

You’reoverweight(denedasBMI>25,but<30)

•

Youhaveafamilyhistoryofdiabetes

•

Youhaveahistoryofgestationaldiabetesorgavebirth

toababyweighingmorethan9pounds

•

You’re65orolder

Medicaremaypayforupto2diabetesscreeningtests

ina12-monthperiod.Aftertheinitialdiabetesscreening

test,yourdoctorwilldetermineifyouneedasecondtest.

Medicarecoversthesediabetesscreeningtests:

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Section 4: Medicare Coverage for Diabetes Services

•

Fastingglucose(sugar)bloodtests

•

OtherglucosebloodtestsapprovedbyMedicareas

appropriate

Ifyouthinkyoumaybeatriskfordiabetes,talkwithyour

doctortoseeifyoucangetthesetests.

Medicare Diabetes Prevention Program

PartBcoversaonce-per-lifetimehealthbehaviorchange

programtohelpyoupreventtype2diabetes.Theprogram

beginswithweeklycoresessionsinagroupsettingovera

6-monthperiod.Inthesesessions,you’llget:

•

Trainingtomakerealistic,lastingbehaviorchanges

arounddietandexercise.

•

Tipsonhowtogetmoreexercise.

•

Strategiestocontrolyourweight.

•

Aspeciallytrainedcoachtohelpkeepyoumotivated.

•

Supportfrompeoplewithsimilargoalsandchallenges.

Onceyoucompletethecoresessions,you’llget6monthly

follow-upsessionstohelpyoumaintainhealthyhabits.

IfyoustartedtheMedicareDiabetesPreventionProgram

in2021orearlier,you’llget12moremonthlysessionsif

youmeetcertainweightlossgoals.

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Section 4: Medicare Coverage for Diabetes Services

Toqualifyyoumusthave:

•

PartB(oraMedicareAdvantagePlan).

•

Afastingplasmaglucoseof110-125mg/dL,a2-hour

plasmaglucoseof140-199mg/dL(oralglucose

tolerancetest),orahemoglobinA1ctestresult

between5.7and6.4%within12monthspriorto

attendingtherstcoresession.

•

Abodymassindex(BMI)of25ormore(BMIof23or

moreifyou’reAsian).

•

Nohistoryoftype1ortype2diabetes.

•

NoEnd-StageRenalDisease(ESRD).

•

NeverparticipatedintheMedicareDiabetesPrevention

Program.

Youpaynothingfortheseservicesifyouqualify.

VisitMedicare.gov/talk-to-someonetoseeifthere’sa

MedicareDiabetesPreventionProgramsupplierinyour

area.

Diabetes self-management training

Diabetesself-managementtraininghelpsyoulearnhowto

successfullymanageyourdiabetes.Yourdoctororother

healthcareprovidermustprescribethistrainingforPartB

tocoverit.

Youcangetdiabetesself-managementtrainingifyou

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Section 4: Medicare Coverage for Diabetes Services

meetoneoftheseconditions:

•

Youwerediagnosedwithdiabetes.

•

Youchangedfromtakingnodiabetesmedication

totakingdiabetesmedication,orfromoraldiabetes

medicationtoinsulin.

•

You’vebeendiagnosedwithdiabetesandareatrisk

forcomplications.

Yourdoctororotherhealthcareprovidermayconsider

youatincreasedriskifanyoftheseapplytoyou:

•

Youhaveproblemscontrollingyourbloodsugar,have

beentreatedinanemergencyroom,orhavestayed

overnightinahospitalbecauseofyourdiabetes.

•

You’vebeendiagnosedwitheyediseaserelatedto

diabetes.

•

Youhavealackoffeelinginyourfeetorsomeother

footproblems,likeulcers,deformities,orhavehadan

amputation.

•

You’vebeendiagnosedwithkidneydiseaserelatedto

diabetes.

Yourdoctororotherhealthcareproviderwillusually

giveyouinformationaboutwheretogetdiabetesself-

managementtraining.Youmustgetthistrainingfrom

anapprovedindividualorprogramaspartofaplan

ofcarepreparedbyyourdoctororotherhealthcare

—

Section 4: Medicare Coverage for Diabetes Services

provider.Theseprogramsandindividualsareaccredited

bytheAmericanDiabetesAssociationortheAmerican

AssociationofDiabetesEducators.

How much training is covered?

Diabetesself-managementtrainingclassesaretaught

byhealthcareprofessionalswhohavespecialtrainingin

diabeteseducation.Medicarewillcoverupto10hoursof

initialtrainingand2hoursoffollow-uptrainingifyouneedit.

Youmustcompletetheinitialtrainingnomorethan12

monthsfromthetimeyoustartit.Theinitialtraining

includesonehouroftrainingonanindividual,one-on-one

basis.Theother9hoursofinitialtrainingareusuallyina

groupsetting.

Important:Yourdoctororotherhealthcareprovidermay

prescribeupto10hoursofinitialtrainingtobeone-on-

oneratherthaninagroupwhenit’sappropriate.Some

signsyoumayneedtogetone-on-onetrainingincludeif

youhavelow-vision,ahearingimpairment,alanguageor

othercommunicationdiculty,orcognitivelimitations.In

addition,Medicarealsocoversone-on-onetrainingifno

groupsareavailablewithin2monthsofthedateofthe

order.

Medicarecoversupto2hoursoffollow-uptrainingeach

yearaftertheyearyougetthersttraining,ifyouneed

it.Tobeeligibleforthefollow-uptraining,youmustget

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Section 4: Medicare Coverage for Diabetes Services

awrittenorderfromyourdoctororotherhealthcare

provider.Thefollow-uptrainingcanbeinagrouporone-

on-onesessions.Remember,yourdoctororotherhealth

careprovidermustprescribethisfollow-uptrainingeach

yearforMedicaretocoverit.

Note:Diabetesself-managementtrainingisavailablein

manyFederallyQualiedHealthCenters(FQHCs).FQHCs

provideprimaryhealthservicesandqualiedpreventive

servicesinmedicallyunderservedruralandurbanareas.

SometypesofFQHCsareCommunityHealthCenters,

MigrantHealthCenters,HealthCarefortheHomeless

Programs,PublicHousingPrimaryCareCenters,and

outpatienthealthprograms/facilitiesoperatedbyatribe

ortribalorganizationorbyanurbanIndianorganization.

Youdon’thavetopayaPartBdeductible.Visit

ndahealthcenter.hrsa.govtondahealthcenternear

you.

Telehealth:Youmaybeabletogetdiabetesself-

managementtrainingfromadoctororotherhealthcare

providerwho’slocatedelsewhereusingaudio-only

(likeyourphone)oraudioandvideocommunication

technology(likeyourcomputer).Formoreinformation

abouttelehealthservices,call1800633-4227.

—

Section 4: Medicare Coverage for Diabetes Services

What will I learn in this training?

Throughdiabetesself-managementtraining,you’lllearn

howtosuccessfullymanageyourdiabetes.Thisincludes

informationonself-careandlifestylechanges.Therst

diabetesself-managementtrainingsessionisanindividual

assessmenttohelptheinstructorsbetterunderstand

yourneeds.

Classroomtrainingwillcovertopicslikethese:

•

Generalinformationaboutdiabetes,thebenetsof

bloodsugarcontrol,andtherisksofpoorbloodsugar

control

•

Nutritionandhowtomanageyourdiet

•

Optionstomanageandimprovebloodsugarcontrol

•

Exerciseandwhyit’simportanttoyourhealth

•

Howtotakeyourmedicationsproperly

•

Bloodsugartestingandhowtousetheinformationto

improveyourdiabetescontrol

•

Howtoprevent,recognize,andtreatacuteandchronic

complicationsfromyourdiabetes

•

Foot,skin,anddentalcare

•

Howdiet,exercise,andmedicationaectbloodsugar

•

Behaviorchanges,goalsetting,riskreduction,and

problemsolving

•

Howtoadjustemotionallytohavingdiabetes

—

Section 4: Medicare Coverage for Diabetes Services

•

Familyinvolvementandsupport

•

Theuseofthehealthcaresystemandcommunity

resources

Medical nutrition therapy services

Inadditiontodiabetesself-managementtraining,Part

Bcoversmedicalnutritiontherapyservicesifyouhave

diabetesorrenaldisease.Tobeeligibleforthisservice,

yourfastingbloodsugarhastomeetcertaincriteria.Also,

adoctormustprescribetheseservicesforyou.

Aregistereddietitianorcertainnutritionprofessionalscan

givetheseservices:

•

Aninitialnutritionandlifestyleassessment

•

Nutritioncounseling(whatfoodstoeatandhowto

followanindividualizeddiabeticmealplan)

•

Howtomanagelifestylefactorsthataectyour

diabetes

•

Follow-upvisitstocheckonyourprogressin

managingyourdiet

Remember,adoctormustprescribemedicalnutrition

therapyserviceseachyearforMedicaretopay.

Note:Medicalnutritiontherapyisavailableinmany

FederallyQualifiedHealthCenters(FQHCs).Visit

findahealthcenter.hrsa.govtofindahealthcenter

nearyou.

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Section 4: Medicare Coverage for Diabetes Services

Telehealth:Youmaybeabletogetmedicalnutrition

therapyfromaregistereddietitianorotherhealthcare

providerwho’slocatedelsewhereusingaudio-only

(likeyourphone)oraudioandvideocommunication

technology(likeyourcomputer).Checkwithyourprovider

toseeifyoucangetsomeoftheseservicesviatelehealth.

Foot exams & treatment

Ifyouhavediabetes-relatednervedamageineitherof

yourfeet,PartBwillcoveronefootexamevery6months

byapodiatristorotherfootcarespecialist,unlessyou’ve

seenafootcarespecialistforsomeotherfootproblem

duringthepast6months.Medicaremaycovermore

frequentvisitsifyou’vehadanon-traumatic(notbecause

ofaninjury)amputationofallorpartofyourfoot,oryour

feethavechangedinappearancewhichmayindicate

youhaveseriousfootdisease.Remember,youshouldbe

underthecareofyourprimarycaredoctorordiabetes

specialistwhengettingfootcare.

Hemoglobin A1c tests

AhemoglobinA1ctestisalabtestthatmeasureshow

wellyourbloodsugarhasbeencontrolledoverthepast

3months.Ifyouhavediabetes,PartBcoversthistestif

yourdoctorordersit.

—

Section 4: Medicare Coverage for Diabetes Services

Formoreinformation,visitMedicare.gov/coverage.

Glaucoma tests

PartBwillpayforyoutohaveyoureyescheckedfor

glaucomaonceevery12monthsifyou’reatincreasedrisk

ofglaucoma.You’reconsideredhighriskforglaucomaif

youhaveanyofthese:

•

Diabeticretinopathy(adiabetescomplicationthat

aectseyes)

•

Afamilyhistoryofglaucoma

•

AreAfrican-Americanand50orolder

•

AreHispanicand65orolder

Thistestmustbedoneorsupervisedbyaneyedoctor

who’slegallyallowedtogivethisserviceinyourstate.

Flu & pneumococcal shots

PartBwillpayforyoutogetaushot(vaccine)generally

onceauseason.PartBwillalsopayforapneumococcal

shot(vaccine)topreventpneumococcalinfections(like

certaintypesofpneumonia).PartBcoversadierent

secondpneumococcalshot11monthsafteryouget

therstshot.Talkwithyourdoctororotherhealthcare

providertoseeifyouneedtheseshots.

—

Section 4: Medicare Coverage for Diabetes Services

“Welcome to Medicare” preventive visit

PartBcoversaone-timereviewofyourhealth,and

educationandcounselingaboutpreventiveservices

withintherst12monthsyouhavePartB.Thisincludes

informationaboutcertainscreenings,shots,andreferrals

forothercareifneeded.The“WelcometoMedicare”

preventivevisitisagoodopportunitytotalkwithyour

doctoraboutthepreventiveservicesyoumayneed,like

diabetesscreeningtests.

Yearly “Wellness” visit

Ifyou’vehadMedicarePartBforlongerthan12months,

youcangetayearly“Wellness”visittodeveloporupdate

apersonalizedpreventionplanbasedonyourcurrent

healthandriskfactors.Thisincludes:

•

Areviewofmedicalandfamilyhistory

•

Alistofcurrentprovidersandprescriptiondrugs

•

Yourheight,weight,bloodpressure,andotherroutine

measurements

•

Ascreeningscheduleforappropriatepreventive

services

•

Alistofriskfactorsandtreatmentoptionsforyou

—

Section 4: Medicare Coverage for Diabetes Services

Supplies & services that Medicare doesn’t cover

OriginalMedicareandMedicaredrugplansdon’tcover

everything.Forexample,thesesuppliesandservices

aren’tcovered:

•

Eyeglassesandexamsforglasses(calledrefraction),

exceptaftercataractsurgery

•

Orthopedicshoes(shoesforpeoplewhosefeetare

impaired,butintact)

•

Cosmeticsurgery

Notes



Section 5:

Helpful Tips &

Resources

Moreinformationisavailabletohelpyoumakehealthcare

choicesanddecisionsthatmeetyourneeds.

FormoreinformationaboutMedicarecoverageof

diabetes,visitMedicare.gov/coverageorcall

1800633-4227.TTYuserscancall1877486-2048.

•

EndofPage

—

Section 5: Helpful Tips & Resources

Tips to help control diabetes

Youcantakeseveralstepstohelpcontrolyourdiabetes.

Herearesometipsthatcanhelpyoustayhealthy:

Eat right

•

Talkwithyourdoctoraboutyoureatinghabits(what,

howmuch,andwhenyoueat).Yourdoctor,diabetes

educator,orotherhealthcareprovidercandevelopa

healthyeatingplanthat’srightforyou.

•

Talkwithyourdoctoraboutyourweight.Yourdoctor

cantalktoyouaboutdierentwaystohelpyoureach

yourgoalweight.

Take medicine as directed

Talkwithyourdoctorifyouhaveanyproblems.

Exercise

Beactiveforatotalof30minutesmostdays.Talkwith

yourdoctoraboutwhichactivitiescanhelpyoustay

active.

Check these things

•

Checkyourbloodsugar(glucose)asoftenasyour

doctortellsyou.Youcanrecordthisinformationina

recordbook.Showyourrecordstoyourdoctor.

—

Section 5: Helpful Tips & Resources

•

Checkyourfeetforcuts,blisters,sores,swelling,

redness,orsoretoenails.It’sveryimportanttokeep

yourfeethealthytopreventseriousfootproblems.

•

Frequentlycheckyourbloodpressure.

•

Haveyourdoctorcheckyourcholesterol.

•

Ifyousmoke,talkwithyourdoctorabouthowyoucan

quit.Medicarewillcounselingtostopsmokingifyour

doctorordersit.

Usingthesetipscanhelpyoumanageyourdiabetes.

Talkwithyourdoctor,diabeteseducator,orotherhealth

careprovideraboutyourtreatment,thetestsyoushould

get,andwhatyoucandotohelpcontrolyourdiabetes.

Youcanalsotalkwithyourdoctoraboutyourtreatment

options.Youandyourdoctorcandecidewhat’sbest

foryou.Youcanalsondoutmorebycontactingthe

organizationsonthenextpage.

—

Section 5: Helpful Tips & Resources

Phone numbers & websites

Centers for Disease Control and Prevention (CDC),

Department of Health and Human Services (HHS)

cdc.gov/diabetes 

1800232-4636

MyHealthnder

healthnder.gov

Indian Health Service

ihs.gov/diabetes/

Diabetes Prevention Program

cdc.gov/diabetes/prevention

National Institute of Diabetes & Digestive & Kidney

Diseases (NIDDK) of the National Institutes of

Health (NIH), HHS

niddk.nih.gov

www.niddk.nih.gov/health-information/diabetes

1800860-8747(Clearinghouse)

Notes



—

CMS Accessible Communications

TheCentersforMedicare&MedicaidServices(CMS)

providesfreeauxiliaryaidsandservices,including

informationinaccessibleformatslikebraille,large

print,dataoraudioles,relayservicesandTTY

communications.Ifyourequestinformationinan

accessibleformatfromCMS,youwon’tbedisadvantaged

byanyadditionaltimenecessarytoprovideit.Thismeans

you’llgetextratimetotakeanyactionifthere’sadelayin

fulllingyourrequest.

TorequestMedicareorMarketplaceinformationinan

accessibleformatyoucan:

1. Call us:ForMedicare:1800633-4227.

TTY:1877486-2048.

2. Send us a fax:1844530-3676.

3. Send us a letter:

CentersforMedicare&MedicaidServices

OcesofHearingsandInquiries(OHI)

7500SecurityBoulevard

MailStopS1-13-25

Baltimore,MD21244-1850

Attn:CustomerAccessibilityResourceSta

Yourrequestshouldincludeyourname,phonenumber,

typeofinformationyouneed(ifknown),andthemailing

addresswhereweshouldsendthematerials.Wemay

contactyouforadditionalinformation.

—

CMS Accessible Communications

Note:Ifyou’reenrolledinaMedicareAdvantagePlan

orMedicaredrugplan,contactyourplantorequestits

informationinanaccessibleformat.ForMedicaid,contact

yourstateorlocalMedicaidoce.

—

Nondiscrimination Notice

TheCentersforMedicare&MedicaidServices(CMS)

doesn’texclude,denybenetsto,orotherwise

discriminateagainstanypersononthebasisofrace,

color,nationalorigin,disability,sex,orageinadmission

to,participationin,orreceiptoftheservicesandbenets

underanyofitsprogramsandactivities,whethercarried

outbyCMSdirectlyorthroughacontractororanyother

entitywithwhichCMSarrangestocarryoutitsprograms

andactivities.

YoucancontactCMSinanyofthewaysincludedinthis

noticeifyouhaveanyconcernsaboutgettinginformation

inaformatthatyoucanuse.

Youmayalsoleacomplaintifyouthinkyou’vebeen

subjectedtodiscriminationinaCMSprogramoractivity,

includingexperiencingissueswithgettinginformationin

anaccessibleformatfromanyMedicareAdvantagePlan,

Medicaredrugplan,stateorlocalMedicaidoce,or

MarketplaceQualiedHealthPlans.

—

Nondiscrimination Notice

TherearethreewaystoleacomplaintwiththeU.S.

DepartmentofHealthandHumanServices,OceforCivil

Rights:

1.Online:

hhs.gov/civil-rights/ling-a-complaint/index.html.

2.By phone:Call1800368-1019.TTYuserscancall

1800537-7697.

3.In writing:Sendinformationaboutyourcomplaintto: 

OceforCivilRights

U.S.DepartmentofHealthandHumanServices

200IndependenceAvenue,SW

Room509F,HHHBuilding

Washington,D.C.20201

ThisproductwasproducedatU.S.taxpayerexpense.

Medicare’s Coverage of Diabetes Supplies, Services,

& Prevention Programs

•

Medicare.gov

•

1800633-4227,TTY:1877486-2048

¿Necesita una copia en español? VisiteMedicare.gov

enelsitioWeb.Parasabersiestapublicaciónesta

impresaydisponible(enespañol),llameGRATISal

1800633-4227.LosusuariosdeTTYdebenllamaral

1877486-2048.

U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

CentersforMedicare&MedicaidServices

7500SecurityBoulevard

Baltimore,Maryland21244-1850

OcialBusiness

PenaltyforPrivateUse,$300

CMSProductNo.11022-LE

RevisedJune2022