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Medicare and Insulin

Diabetes is a common condition, which occurs due to the reduced ability of the pancreas to make enough insulin or the reduced ability of the cells to respond to the insulin. Healthy cells in the body use insulin to metabolize sugars.

The lack of insulin can prevent the cells from processing sugars due to which the blood sugar level rises. If your blood sugar levels remain consistently high, the diagnosis of diabetes could be confirmed.

The patients with diabetes are advised to use insulin injections to replenish the lack of this hormone in the body. Insulin injections are usually recommended for patients who suffer from type 1 diabetes caused due to the reduced production of this hormone in the pancreas.

If your doctor has advised you to use insulin, read this article to learn whether this medication is covered by Medicare.

elderly man checks blood sugar

Does Medicare help pay for insulin?

Medicare Part B and Part D usually cover the supplies and services needed to manage diabetes as described below.

Medicare Part B coverage for diabetes

Medicare Part B usually covers insulin and an external insulin pump as DME (durable medical equipment). You need to pay 20% of the costs approved by Medicare after the annual Medicare Part B deductible.

Diabetes can also affect the circulation of blood to the vital organs. This can result in life-threatening consequences.  Poor blood circulation can increase the risk of foot diseases.

Hence, patients need to check their blood sugar levels on a regular basis and alter the dose of insulin accordingly to make sure the complications are avoided.

Medicare Part B also covers foot examination once in every six months as long as the patient has not seen a foot care physician for any other reason. Therapeutic shoe recommended for patients with diabetes is also covered when the need for special footwear is recommended by the physician.

This coverage will be in addition to the costs of insulin injections reimbursed by your policy.

The extra coverage would offer additional protection to the patients by allowing them to assess their control over diabetes and change the doses of insulin injections.

Medicare Part D coverage for diabetes

Medicare Part D offers coverage for prescription drugs that are available through a Medicare Advantage Prescription Drug plan or Medicare prescription drug plan. Since insulin is a prescription drug recommended for the management of diabetes, it is covered by Medicare Part D.

However, Medicare Part D would not cover insulin when it is administered using an insulin pump.

In this case, insulin would be covered under Part B of Medicare as durable medical equipment. Medicare Part D would also cover other drugs prescribed to control diabetes.

If you’re diagnosed with diabetes, you may need additional medical supplies to administer the doses of the hormone. These supplies may include needles, gauze, alcohol swabs, syringes, and inhaled insulin devices. These medicinal supplies are covered by Medicare Part D.


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