Diabetic Medications Covered by Medicare

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Russell Noga
by Russell Noga | Updated December 11th, 2023

Diabetic Medications Covered by Medicare IntroAre you one of the millions of Americans on Medicare and living with diabetes?

If so, understanding your Medicare coverage for diabetes medications and supplies is essential, especially when it comes to which diabetic medications are covered by Medicare.

With the right knowledge, you can manage your condition more effectively and potentially save on out-of-pocket costs. This article will guide you through the ins and outs of Medicare coverage for diabetes medications, diabetic medications covered by Medicare, preventative services, and available assistance programs.

Get ready to take control of your diabetes care and live a healthier life!


Key Takeaways

  • Medicare offers coverage for diabetes medications, supplies, and services through Part B, D & C.
  • Types of diabetic medications covered include insulin, oral medications, and injectable non-insulin drugs.
  • Maximize Medicare coverage by choosing the right plan, working with healthcare providers & utilizing manufacturer rebates/patient assistance programs.


Diabetic Medications Covered by Medicare Understanding Medicare and Diabetes MedicationsUnderstanding Medicare and Diabetes Medications

Navigating the world of Medicare and diabetes medications can seem overwhelming at first. However, with the right information, you can better understand your coverage options and choose the plan that best suits your needs.

Medicare offers coverage for numerous diabetes medications, supplies, and services through different parts of its program, such as Part B, Part D, and Medicare Advantage Plans (Part C).

Understanding these options can enable you to decide wisely about your diabetes care and possibly reduce out-of-pocket expenses.


Medicare Part B

Medicare Part B is a health insurance program that covers a range of outpatient services, treatments, and durable medical equipment for diabetic patients, including insulin pumps and certain medications, with medicare pay taking care of these expenses.

For instance, Medicare Part B covers therapeutic continuous glucose monitors, such as Freestyle Libre 2 and Dexcom G6, which are essential for tracking blood sugar levels. However, it’s important to note that Medicare Part B does not typically provide coverage for prescription diabetic medications.

In such cases, you may need to turn to Medicare Part D for coverage of a variety of anti-diabetic drugs.


Medicare Part D

Medicare Part D provides prescription drug coverage to all eligible Medicare beneficiaries. It is a comprehensive program available to its members. It provides coverage for prescription medications for diabetes treatment, including oral medications.

Insulin and insulin administration supplies, such as:Diabetic Medications Covered by Medicare Medicare Part D

  • injectable insulin
  • syringes
  • insulin pens
  • needles
  • alcohol swabs
  • gauze

Many prescription medications are covered by Medicare Part D, and some medical supplies are also covered under Part D, falling under the category of medicare coverage. Additionally, private insurance companies may offer supplemental coverage for items not covered by Medicare.

To receive coverage for necessary diabetes medications, enrollment in a Part D plan and a review of the plan’s formulary, which lists the covered medications, is needed.


Diabetic Medications Covered by Medicare Medicare Advantage Plans (Part C)Medicare Advantage Plans (Part C)

Medicare Advantage Plans (Part C) is a combination of Parts A, B, and D coverage, providing comprehensive diabetes care with restricted provider networks. These plans consolidate all coverage into a single plan, often offering additional benefits associated with diabetes.

To obtain further information regarding Medicare Advantage plans, kindly visit www.medicare.gov or contact 1-800-MEDICARE (800-633-4227). Keep in mind that Medicare Advantage plans may impose varying out-of-pocket costs and may have different regulations regarding how beneficiaries access services.


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Types of Diabetic Medications Covered by Medicare

Having gained a basic understanding of how Medicare covers diabetes medications and supplies, we can now examine the specific types of diabetic medications that Medicare covers. These include insulin, oral medications, and injectable non-insulin medications.

Knowing the types of medications covered can help you and your healthcare provider make informed decisions about your diabetes treatment plan.


InsulinDiabetic Medications Covered by Medicare Insulin

Insulin is a vital component of diabetes care, and Medicare offers coverage for insulin costs in outpatient settings, insulin pumps as durable medical equipment, and injectable insulin at home through Part D.

Injectable and inhalable insulin can be obtained with a Medicare Part D prescription plan or a Medicare Advantage plan that includes prescription coverage. Both plans come with access to these forms of medicine.

Working closely with your healthcare provider to secure proper documentation and prescriptions for Medicare-covered insulin is key.


Oral Medications

Oral medications play a crucial role in diabetes treatment. Medicare Part D provides coverage for a range of oral medications for diabetes, including:

  • Sulfonylureas
  • Biguanides
  • Thiazolidinediones
  • Alpha-glucosidase inhibitors
  • DPP-4 inhibitors
  • SGLT2 inhibitors

Review the specific formulary of your Medicare Part D plan to ensure that the oral medications you require are covered.


Injectable Non-Insulin Medications

Medicare also covers injectable non-insulin medications, such as GLP-1 receptor agonists, through Part D plans. These medications can be an essential component of a comprehensive diabetes treatment plan.

Consult with your healthcare provider and review your Medicare Part D plan coverage to determine if injectable non-insulin medications are appropriate for your diabetes care.


Diabetic Medications Covered by Medicare Preventative Services and Support for DiabeticsPreventative Services and Support for Diabetics

In addition to covering diabetes medications, Medicare also offers preventative services and support for diabetics. These services include diabetes screenings, diabetes self-management training, and medical nutrition therapy.

By taking advantage of these services, you can better manage your diabetes and prevent complications.


Diabetes Screenings

Medicare Part B covers up to two free diabetes screenings per year for eligible beneficiaries. These screenings can help detect potential complications early, allowing for prompt intervention and treatment.

Early detection is crucial for preventing or reducing the consequences of complications related to diabetes, so it’s essential to take advantage of these screenings.


Diabetic Medications Covered by Medicare Diabetes Self-Management TrainingDiabetes Self-Management Training

Medicare Part B covers self-management training for diabetics, including individual and group sessions. Diabetes Self-Management Training (DSMT) is the ongoing process of providing the necessary knowledge, skills, and ability for diabetes self-care, including healthy eating and physical activity.

Participation in DSMT can equip you with the knowledge and skills needed to manage your health effectively and enhance your overall well-being.


Medical Nutrition Therapy

Medical Nutrition Therapy (MNT) is a personalized approach to nutrition management that seeks to improve diabetes management by focusing on a balanced diet that emphasizes vegetables low in carbohydrates, healthy fats, and lean proteins. Medicare Part B covers medical nutrition therapy for diabetics with a referral from a healthcare provider.

MNT can aid in normalizing blood glucose and lipid levels, support weight loss or stabilization, and contribute to overall health for those with diabetes.


Diabetic Medications Covered by Medicare

Medicare Savings Programs and Assistance for Diabetics

For individuals struggling with the costs of diabetes care, there are several Medicare savings programs and assistance options available. These programs can help reduce out-of-pocket costs for diabetes medications and supplies, making it easier for you to manage your condition.

We proceed to discuss the Medicare Extra Help program, the Senior Savings Model, and other Medicare savings programs available to those with diabetes.


Medicare Extra HelpDiabetic Medications Covered by Medicare Medicare Extra Help

The Medicare Extra Help program is a federal program that provides additional coverage for individuals with Medicare to decrease the cost of prescription drugs, including the option of medicare supplement insurance. It can aid diabetics by reducing the cost of their diabetes medications, including insulin.

To determine if you’re eligible for the Extra Help program, visit the Medicare Extra Help Program website or contact 1-800-MEDICARE (800-633-4227).


Medicare Senior Savings Model

The Senior Savings Model is a program that provides additional savings for Medicare beneficiaries with Part D. It can assist in reducing the cost of prescription drugs for those who are eligible, including various types of insulin at a maximum copayment of $35 for a 30-day supply.

To apply for the Part D Senior Savings Model, you must enroll in a Medicare Part D prescription drug plan that participates in the model.


Diabetic Medications Covered by Medicare Other Medicare Savings ProgramsOther Medicare Savings Programs

In addition to the Extra Help program and the Senior Savings Model, there are other Medicare savings programs available to individuals with diabetes, such as Medicare Advantage Special Needs Plans and state-based assistance programs.

These programs may offer financial assistance, education, and other resources to assist Medicare beneficiaries with diabetes in managing their condition effectively.

To learn more about these programs, consult your healthcare provider, or seek guidance from your local State Health Insurance Assistance Program (SHIP) counselor.


Tips for Maximizing Medicare Coverage for Diabetes Medications

Now equipped with a stronger understanding of Medicare coverage for diabetes medications, we can consider some tips for optimizing your coverage.

Opting for the right plan, collaborating with your healthcare provider, and making use of manufacturer rebates and patient assistance programs can enhance your Medicare coverage and enable more effective management of your diabetes.


Choosing the Right Plan

Selecting a Medicare plan that best meets your diabetes care needs is crucial. Whether you opt for a Part D plan or a Medicare Advantage plan with drug coverage, make sure to:

  • Review the plan’s formulary, which lists the covered medications
  • Verify if the pharmacies you prefer to use are part of the plan network
  • Double check to make sure the plan covers the specific diabetes supplies and services you require

By taking these steps, you can ensure that you choose a Medicare plan that provides the necessary coverage for your diabetes care.

A careful evaluation of your options can guide you to select a plan that delivers the best coverage for your diabetes medications and diabetic supplies.


Diabetic Medications Covered by Medicare Working with Your Healthcare ProviderWorking with Your Healthcare Provider

A strong collaboration with your healthcare provider is necessary to secure the right documentation and prescriptions for Medicare-covered diabetes medications and supplies.

Your healthcare provider can also guide you in selecting an appropriate Medicare plan for diabetes care, providing information about Medicare coverage for diabetes-related services and supplies.

Maintaining a strong relationship with your healthcare provider can improve your diabetes care and help avoid complications.


Utilizing Manufacturer Rebates and Patient Assistance Programs

Taking advantage of manufacturer rebates and patient assistance programs can help reduce out-of-pocket costs for diabetes medications and supplies. These programs are offered by pharmaceutical companies and provide financial assistance or discounts for eligible individuals.

Contact the relevant pharmaceutical company or visit their website to learn more about the application process and eligibility criteria.

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In conclusion, understanding Medicare coverage for diabetes medications and supplies is essential for effectively managing your condition.Diabetic Medications Covered by Medicare Summary

By familiarizing yourself with the different parts of Medicare, such as Part B, Part D, and Medicare Advantage Plans, you can make informed decisions about your diabetes care and potentially save on out-of-pocket costs.

Remember to collaborate with your healthcare provider, choose the right plan, and utilize manufacturer rebates and patient assistance programs to maximize your Medicare coverage.

Embrace a healthier future by taking control of your diabetes care with the help of Medicare!

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Frequently Asked Questions


  What diabetic medication does Medicare pay for?

Medicare Part D covers injectable insulin not used with an insulin infusion pump, as well as certain medical supplies needed to inject insulin such as syringes, gauze, and alcohol swabs. Additionally, Medicare plans cover Adlyxin®, Byetta®, Bydureon®, Ozempic®, Tanzeum®, Trulicity®, and Victoza®.


  Is Ozempic covered by Medicare?

No, Medicare does not cover Ozempic for weight loss as it excludes medications prescribed for non-cosmetic purposes such as morbid obesity. However, if the drug is prescribed to control type 2 diabetes, then it is covered under Medicare Part D.


  What are the $35 insulins?

The $35 insulins are Part-D covered insulin products from Lilly Insulin Value Program and the Medicare Part D Savings Model, making them accessible for people with or without insurance at a set price of $35 per month.


  How does Medicare Part B cover diabetes supplies and services?

Medicare Part B covers various diabetes supplies and services, such as outpatient treatments, durable medical equipment and medications.


  Are there any Medicare savings programs available for diabetics?

Yes, Medicare offers a range of savings programs specifically for diabetics, including Extra Help, the Senior Savings Model and more.

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