Your Guide to Medicare Coverage and Diabetes

What does Medicare cover for people with diabetes?

Medicare covers 80% of the below products. Insurance holders by an annual deductible as well as the remaining 20% of all expenses. Some individuals may have private insurance to supplement this remaining 20%, making many of these items free of charge for insurance and Medicare holders.

The information listed below is subject to change at any time. Please check directly with Medicare to confirm coverage.

What does Medicare cover for people with diabetes?

Medical Equipment for Diabetes Covered By Medicare Part B

Item How often is it covered? Necessary documents for coverage
Blood sugar monitors This is considered durable medical equipment (DME). Amounts and type are based on the prescription. Medicare specifically covers continuous glucose monitors. Doctor's prescription and proof of purchase or rental from a supplier enrolled with Medicare.
Blood sugar test strips This is considered durable medical equipment (DME). Amounts and type are based on the prescription. Doctor's prescription and proof of purchase from a supplier enrolled with Medicare.
Insulin used in a medically necessary insulin pump(Note: Insulin is not covered by Part B unless used in an insulin pump. Similarly, Medicare users must pay 100% for insulin pens, syringes, needles, alcohol swabs and gauze. Non-pump insulin may be covered by Medicare Part D) This is considered durable medical equipment (DME). Amounts and type are based on the prescription. Doctor's prescription, proof of insulin pump purchase from a supplier enrolled with Medicare, proof of insulin purchase from Medicare-approved supplier.
Lancet devices & lancets This is considered durable medical equipment (DME). Amounts and type are based on the prescription. Doctor's prescription and proof of purchase or rental from a supplier enrolled with Medicare.
Therapeutic shoes One pair of custom-molded shoes and inserts or one pair of extra-depth shoes. Doctor's prescription, a shoe fitting from a certified professional, and purchase from a supplier enrolled with Medicare (such as No Cost Shoes).
Therapeutic shoe inserts 2 pairs of inserts for custom-molded shoes or 3 pairs of inserts for extra depth shoes per calendar year. Doctor's prescription, a shoe fitting from a certified professional, and purchase from a supplier enrolled with Medicare (such as No Cost Shoes).

Medical Services for Diabetes Covered By Medicare Part B

Item How often is it covered? Necessary documents for coverage
Diabetes self-management training In year one, Medicare may cover up to 1 hour of individual DSMT training and up to 9 hours of group training (10 hours total). In subsequent years, Medicare may cover up to 2 hours of follow-up training per year. Written order from a doctor or qualified practitioner signifying risk for diabetes complications and proof of supply from an approved DSMT provider.
Eye exam One exam for diabetic retinopathy per year. Billing from a doctor legally allowed to conduct this exam in your state.
Glaucoma Tests One exam every 12 months. Proof that you are at high risk for glaucoma (this applies to anyone with diabetes) and billing from a doctor legally allowed to conduct this exam in your state.
Medical Nutrition Therapy Initial nutrition and lifestyle assessment, individual and/or group nutrition therapy services, and follow-up visits as needed. Referral from your doctor for this service and billing from a Registered Dietitian.

Prescriptions for Diabetes Covered By Medicare Part D

 

If you have opted into Medicare Part D, your prescription medication for managing diabetes such as insulin may be partially or fully covered. It may also cover supplies to use the insulin, such as syringes and gauze.

What documentation do I need?

In most cases, two professionals/companies are involved in coverage of diabetic services and equipment: The qualifying physician and the supplier.

 

Here's how it works in the case of diabetic shoes covered:

 

First, you will need a Certificate of Medical Necessity (CMN). This is to confirm that you need the shoes to be covered by Medicare. This form must be filled out by an MD or DO. Usually, this is your family doctor.

Then, you will need the Shoe Prescription. Typically, your family doctor will fill this out along with the CMN. Other times, a podiatrist or foot professional will complete this document. It can be signed by an MD, DO, NP or DPM.

These two documents can be filled out in any order. For example, your doctor can create a CMN after a nurse practitioner or podiatrist writes you a shoe prescription. If you need help with obtaining these documents part, just let us know help - No Cost Shoes is happy to send a fax or two to confirm your coverage!

Finally, you will need to get shoes from an eligible supplier. We recommend finding a supplier that can directly bill Medicare. You should also look for suppliers that can give you some choice to find the right fit. For example, No Cost Shoes gives you access to in-home shoe fitting along with access to multiple top diabetic shoe brands.

Direct Billing versus Applying for Coverage With Medicare

Wherever possible, try to find suppliers that can directly bill Medicare for you. There are a few reasons this is often the better option:

  • With direct billing, there is no need to pay costs upfront and wait for an insurance check;
  • When a doctor or supplier can bill Medicare directly, it proves that they are an eligible supplier;
  • A doctor or supplier who bills directly will be able to educate you on the proper paperwork you need, submitting it directly to insurance to save you time.

 

When you find a supplier or professional that is able to bill Medicare directly, such as No Cost Shoes, they will likely ask for some paperwork from your family doctor. They may need to fax your family doctor additional documents to sign, as Medicare will only provide most products or services to individuals with a proven need.

Who qualifies for Medicare coverage with diabetic shoes and inserts?

Many people with diabetes experience foot issues and will have their shoes and inserts covered by Medicare. Doctors will fill out a Certificate of Medical Necessity for diabetic shoes if a person has an issue such as:

  • Hammertoes;
  • Bunions;
  • Calluses;
  • Corns;
  • Previous history of ulcerations;
  • Amputations of toes or part of foot;
  • Poor circulation;
  • Neuropathy.

 

If you have diabetes are experiencing any of these foot complications, your shoes will most likely be covered by Medicare.

Want to see if your shoes and inserts are covered by Medicare?