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Does my Medicare drug plan cover diabetic test strips?

Category: Insulin and Diabetic Supplies
Updated: Jan, 11 2023


No.  Your Medicare Part D prescription drug plan will not cover your glucose test strips - instead, diabetic test strips are covered by Medicare Part B as Durable Medical Equipment (DME).

However, your Medicare Part D plan may cover other diabetic supplies such as syringes or alcohol swabs - see the Part B v. Part D chart further down the page.

As reference, the Medicare document, "Medicare's Coverage of Diabetes Supplies & Services" notes in the section "Blood sugar self-testing equipment & supplies":

"[Medicare] Part B covers blood sugar (also called blood glucose) self-testing equipment and supplies as durable medical equipment for all people with Medicare Part B who have diabetes, even if you don't use insulin.

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

Part B covers the same type of blood sugar testing supplies for people with diabetes whether or not they use insulin.  However, the amount of supplies that are covered 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."  [with additional information from earlier versions of the same CMS publication]


More about the extent of Medicare Part B coverage for Diabetic Supplies

The chart below highlights the frequency or limits of Medicare Part B coverage for specific diabetic supplies.

Diabetic Supplies If you use Insulin If you do not
use Insulin
Glucose Meters and Monitoring Systems 1 every 5 years 1 every 5 years
Test Strips 100 per month
(up to 300 per 3 months)
100 every 3 months
Lancing Device  1 every 6 months  1 every 6 months
Lancets  100 per month
(up to 300 per 3 months)
 100 every 3 months
 
Cost of Medicare Part B diabetic supply coverage?

Your Medicare plan's deductible, insurance from other policies, and copays (the amount you pay out-of-pocket) may apply, but, in general, Medicare will reimburse 80% of the Medicare allowed amount or 80% of the retail price for the diabetic supplies covered by Part B, whichever is less.

Mail Order Program for Diabetic Supplies

Please also note that in Medicare also has a mail order program for diabetic supplies and you can read more in our article:
"Medicare's National Mail-order Program for Diabetic Testing Supplies starts in July [2013]" found here: Q1News.com/291

A few additional notes on the specific coverage of Diabetic Test Strips


As noted above, Diabetic Testing supplies are covered by Medicare Part B and you should find that Diabetic Test Strips are covered economically by a Medicare Advantage plan (MA or MAPD) or a Medicare Supplement (Medigap Policy) - possibly at a cost of less than the Part B 20% copay.  You can contact your Medicare Advantage plan or Medicare Supplement using the telephone number found on your Member ID card for more information about what you will pay for diabetic supplies.


Medicare Part B v. Medicare Part D coverage of different diabetic supplies

The coverage of different types of diabetic supplies are actually split across two parts of Medicare:
Medicare Part B (out-patient care) and Medicare Part D (prescription drug coverage).

As noted by Medicare:
In general, Medicare Part B (out-patient medical insurance) covers the services that may affect people who have diabetes. Medicare Part B also covers some preventive services for people who are at risk for diabetes.  For instance, Glucose Meters, Meter replacement batteries, Test Strips, Lancets, Lancet Devices, Control Solutions are covered under your Medicare Part B.

Alternatively, Medicare Part D drug plans cover diabetes supplies used for injecting or inhaling insulin (for instance, syringes and insulin are covered under your Medicare Part D prescription drug plan).
Practical noteYou must be enrolled in Medicare Part B to get services and supplies covered under Part B - and you must be enrolled in a Medicare Part D prescription drug plan (PDP) - or a Medicare Advantage plan that includes prescription drug coverage (MAPD) to get supplies covered under Medicare Part D.

The following chart was provided by Medicare and illustrates how different parts of Medicare cover different diabetic supplies.

Supply or Service
 What is covered under Medicare Part D or Part B?
 What you pay
Anti-diabetic drugs
Medicare Part D covers anti-diabetic drugs for maintaining blood sugar (glucose).  [please see our Q1Rx Drug Finder for coverage of specific prescriptions Q1Rx.com]
Your drug plan's coinsurance or copayment - your Medicare Part D deductible may also apply
Diabetes supplies
Medicare Part D covers certain medical supplies for administration of insulin (like syringes, insulin pens, needles, lancets, alcohol swabs, gauze, disposable insulin pumps, and inhaled insulin devices).
Your drug plan's coinsurance or copayment - your Medicare Part D deductible may also apply
Insulin* Medicare Part D covers injectable insulin and insulin supplied through a disposable insulin pump.  Starting in 2023, all insulin covered by a Part D plan will cost $35 or less for a 30-day supply through all parts of coverage.

Medicare Part B (starting July 1, 2023) will cover a 30-day insulin supply delivered through a traditional insulin pump for $35.
Your drug plan's coinsurance or copayment will not exceed $35 for a 30-day supply - your Medicare Part D deductible will not apply to insulin purchases.
Diabetes screenings
Medicare Part B covers these screenings if your doc­tor determines you’re at risk for diabetes. You may be eligible for up to 2 diabetes screenings each year.
No coinsurance, copayment, or Part B deductible - generally, 20% of the Medicare-approved amount for the doctor’s visit
Traditional Insulin pumps* Medicare Part B covers external traditional (non-disposable) insulin pumps and the insulin that the device uses under durable medical equipment for people who meet certain conditions.
20% of the Medicare-approved amount after the yearly Part B deductible
Diabetes self- management training
Medicare Part B covers outpatient training for people at risk for complications from diabetes or recently diagnosed with diabetes to teach them to manage their diabetes. Your doctor or other health care provider must provide a written order to a certified diabetes self-management education program.
20% of the Medicare-approved amount after the yearly Part B deductible
Diabetes equipment and supplies
Medicare Part B covers home blood sugar (glucose) monitors under durable medical equipment and supplies used 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.
20% of the Medicare-approved amount after the yearly Part B deductible

_____________________________________


As reference:

CMS - Medicare's Coverage of Diabetes Supplies & Services" notes in the section "Blood sugar self-testing equipment & supplies  (Publication 11022)

_____________________________________
* Important changes started on January 1, 2023:

The Inflation Reduction Act (IRA) of 2022 expands the insulin $35 copay to all Medicare Part D plans (PDP and MAPD) and all Part D forms of insulin covered by the plan - and beginning July 1, 2023, insulin furnished through Medicare Part B durable medical equipment (DME) will also have a monthly copay of no more than $35.  Then, starting in 2026, the government can begin negotiating drug prices, so the copay for insulin may be less than $35 depending on the negotiated price.





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