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CENTERS FOR MEDICARE & MEDICAID SERVICES

Medicare Coverage of

Diabetes Supplies &

Services

This official government booklet has

important information about the following:

• What’s covered

• What’s not covered

• Helpful tips to keep you healthy

• Where to get more information
Table of Contents

Introduction ....................................................................................................1–2

Section 1: Medicare Coverage for Diabetes At-a-Glance ............3–6

Section 2: Medicare Part B-covered Diabetes Supplies ..............7–11

Blood sugar self-testing equipment and supplies ................................................7–9

Insulin pumps ......................................................................................................10

Therapeutic shoes or inserts............................................................................10–11

Section 3: Medicare Part D Diabetes Coverage............................13–14

Insulin ..................................................................................................................13

Anti-diabetic drugs ..............................................................................................13

Diabetes supplies ..................................................................................................14

Section 4: Medicare-covered Diabetes Services ..........................15–21

Diabetes screenings ........................................................................................15–16

Diabetes self-management training ................................................................16–18

Medical nutrition therapy services ........................................................................19

Foot exams and treatment ....................................................................................20

Hemoglobin A1c tests ..........................................................................................20

Glaucoma tests ....................................................................................................20

Special eye exams..................................................................................................20

Flu and pneumococcal shots ................................................................................20

Physical exam—“Welcome to Medicare” physical exam ......................................21

Supplies and services that aren’t covered by Medicare ..........................................21

Section 5: Helpful Tips and Resources..............................................23–26

Information for people with limited income and resources ..................................23

Tips to help control diabetes ................................................................................24

Telephone numbers and websites....................................................................25–26

This booklet explains your benefits in Original Medicare. “Medicare Coverage of

Diabetes Supplies & Services” isn’t a legal document. Official Medicare Program legal

guidance is contained in relevant statutes, regulations, and rulings.
Introduction

This booklet explains Medicare coverage of diabetes supplies and services in

Original Medicare and with Medicare prescription drug coverage (Part D).

Original Medicare is fee-for-service coverage under which the government

pays your health care providers directly for your Part A and/or Part B benefits.

If you have other insurance that supplements Original Medicare, like a

Medigap (Medicare Supplement Insurance) policy, it may pay some of the

costs for the services described in this booklet. Contact your plan’s benefits

administrator for more information.

If you are in a Medicare Advantage Plan (like an HMO or PPO) or other

Medicare health plan, your plan must give you at least the same coverage as

Original Medicare, but it may have different rules. Your costs, rights, 

protections, and choices for where you get your care might be different if

you are in one of these plans. You might also get extra benefits. Read your

plan materials, or call your benefits administrator, for more information

about your benefits.

What Is Medicare?

Medicare is health insurance for people age 65 or older, under age 65 with

certain disabilities, and any age with End-Stage Renal Disease (ESRD)

(permanent kidney failure requiring dialysis or a kidney transplant).

1
The Different Parts of Medicare

The different parts of Medicare help cover specific services if you meet certain 

conditions. Medicare has the following parts: 

Medicare Part A (Hospital Insurance) helps cover your inpatient care in hospitals.

Part A also helps cover skilled nursing facility, hospice, and home health care. 

Medicare Part B (Medical Insurance) helps cover doctors’ services and outpatient

care. Part B also helps cover some preventive services to help maintain your health

and to keep certain illnesses from getting worse. 

Medicare Part C (Medicare Advantage Plans) (like an HMO or PPO) is a

health coverage choice run by private companies approved by Medicare. It includes

Part A, Part B, and, usually other coverage including prescription drugs. These

plans must cover medically-necessary services. However, plans can charge different

copayments, coinsurance, or deductibles for these services. 

Medicare Part D (Prescription Drug Coverage) helps cover the cost of 

prescription drugs. This coverage may help lower your prescription drug costs and

help protect against higher costs in the future. For more information about Medicare,

visit www.medicare.gov/Publications/Pubs/pdf/10050.pdf to view the handbook,

“Medicare & You,” or call 1-800-MEDICARE (1-800-633-4227). TTY users should call

1-877-486-2048.

Before you read the following sections, you should become familiar with the terms

listed below:

Coinsurance: This is 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%).

Deductible: This is the amount you must pay for health care or prescriptions, before

Original Medicare, your prescription drug plan, or your other insurance begins to pay.

Medicare-approved Amount: In Original Medicare, this is the amount a doctor or

supplier that accepts assignment can be paid. It includes what Medicare pays and

any deductible, coinsurance, or copayment that you pay. It may be less than the

actual amount a doctor or supplier charges.

Introduction 

2
Section 1: Medicare Coverage for Diabetes At-a-Glance

3

The chart below and on pages 4–6 provides a quick overview of some of the services and 

diabetes supplies covered by Medicare (Part B and Part D). Generally, Medicare Part B 

(Medical Insurance) covers the services that may affect people who have diabetes. In addition,

Medicare Part B covers some preventive services for people who are at risk for diabetes.

Medicare Part D (Medicare prescription drug coverage) also covers diabetes supplies used for

injecting insulin. You must have Medicare Part B and/or Part D to get these covered services

and supplies.

1

Supply/Service What is covered You pay

Anti-diabetic drugs Medicare Part D covers anti-diabetic

drugs for maintaining blood sugar 

(glucose).

Coinsurance or copayment

Part D deductible may also

apply

Diabetes

screenings 

See pages 15–16. 

Medicare Part B covers tests to check for

diabetes. These screenings are covered if you

have any of the following risk factors: high

blood pressure (hypertension), history of

abnormal cholesterol and triglyceride levels

(dyslipidemia), obesity, or a history of high

blood sugar. Tests are also covered if you

answer “yes” to two or more of the 

following questions:

• Are you age 65 or older?

• Are you overweight?

• Do you have a family history of diabetes

(parents, siblings)?

• Do you have a history of gestational 

diabetes (diabetes during pregnancy),or

did you deliver a baby weighing more

than 9 pounds?

Based on the results of these tests, you

may be eligible for up to two diabetes

screenings every year.

No coinsurance, 

copayment, or Part B

deductible

Generally, 20% of the

Medicare-approved amount

for the doctor’s visit 
4

Section 1: Medicare Coverage for Diabetes At-a-Glance

Supply/Service What is covered You pay

Diabetes selfmanagement

training 

See pages 16–18.

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 Medicareapproved amount after the

yearly Part B deductible.

Diabetes

supplies 

(Part B)

(Blood sugar 

self-testing 

equipment and 

supplies on pages 7–9) 

Medicare Part B covers some diabetes 

supplies, including blood sugar (glucose)

testing monitors, blood sugar (glucose) test

strips, lancet devices and lancets, and 

therapeutic shoes (in some cases). There

may be limits on how much or how often

you get these supplies.

20% of the Medicareapproved amount after the

yearly Part B deductible.

Diabetes

supplies 

(Part D)

See page 14.

Medicare Part D covers certain medical

supplies for administration of insulin

(like syringes, needles, alcohol swabs,

gauze, and inhaled insulin devices).

Coinsurance or copayment

Part D deductible may also

apply

Flu and 

pneumococcal shots

See page 20.

Flu shot

To help prevent influenza or flu virus. This

is covered once a flu season in the fall or

winter. You need a flu shot for the current

virus each year. Medicare Part B covers this

shot. 

Pneumococcal shot

To help prevent pneumococcal infections

(like certain types of pneumonia). Most

people only need this preventive shot

once in their lifetime. Medicare Part B

covers this shot. 

No coinsurance or

copayment or Part B

deductible if your doctor

or health care provider

accepts assignment.
5

Supply/Service What is covered You pay

Foot exams and

treatment 

See page 20.

Medicare Part B covers a foot exam every

6 months for people with diabetic

peripheral neuropathy and loss of 

protective sensation, as long as they

haven’t seen a foot care professional for

another reason between visits.

20% of the Medicareapproved amount after the

yearly Part B deductible.

Glaucoma tests 

See page 20.

Medicare Part B covers tests to help find

the eye disease glaucoma. This is covered

once every 12 months for people at high

risk for glaucoma. You are considered

high risk for glaucoma if you have 

diabetes, or a family history of glaucoma,

or are African-American and age 50 or

older, or are Hispanic and age 65 or

older. Tests must be done by an eye 

doctor legally authorized by the state.

20% of the Medicareapproved amount after the

yearly Part B deductible.

Insulin

See page 13.

Medicare Part D covers insulin that isn’t

administered with an insulin pump.

Coinsurance or copayment

Part D deductible may also

apply 

Insulin pumps 

See page 10.

Medicare Part B covers external insulin

pumps and the insulin that the device

uses under durable medical equipment

for people who meet certain conditions. 

20% of the Medicareapproved amount after the

yearly Part B deductible.

Medical

nutrition

therapy 

See page 19.

Medicare Part B may cover medical

nutrition therapy and certain related 

services if you have diabetes or kidney

disease, and your doctor refers you for

the service. 

20% of the Medicareapproved amount after the

yearly Part B deductible.

Section 1: Medicare Coverage for Diabetes At-a-Glance
6

Section 1: Medicare Coverage for Diabetes At-a-Glance

Supply/Service What is covered You pay

Physical exam

(“Welcome to

Medicare” physical

exam) 

See page 21.

Medicare Part B 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. 

Note: In 2008, exam must be done in

the first 6 months you have Medicare

Part B. In 2009, exam will be covered if

you get it within the first 12 months you

have Part B, even if the effective date of

your Part B enrollment begins in 2008.

2008

Coinsurance or

copayment and Part B

deductible applies

2009

20% of the Medicareapproved amount, and 

no Part B deductible

Therapeutic shoes

or inserts 

See pages 10–11.

Medicare Part B covers therapeutic shoes

or inserts for people with diabetes who

have severe diabetic foot disease. The 

doctor who treats your diabetes must 

certify your need for therapeutic shoes or

inserts. The shoes and inserts must be 

prescribed by a podiatrist or other qualified

doctor and provided by a podiatrist, 

orthotist, prosthetist, or pedorthist.

20% of the Medicareapproved amount after the

yearly Part B deductible.
7

Section 2: Medicare Part B-covered Diabetes Supplies 2 This section provides information about Medicare Part B (Medical 

Insurance) and its coverage of diabetes supplies. Medicare covers certain

supplies if you have diabetes and you have Medicare Part B. These 

covered supplies include the following:

• Blood sugar self-testing equipment and supplies. See below and 

pages 8–9.

• Insulin pumps. See page 10.

• Therapeutic shoes or inserts. See page 10.

Blood sugar self-testing equipment and supplies

Blood sugar (also called blood glucose) self-testing equipment and 

supplies are covered for all people with Medicare Part B who have 

diabetes, even if you don’t use insulin.

Self-testing supplies include the following:

• Blood sugar monitors

• Blood sugar test strips

• Lancet devices and lancets

• Glucose control solutions for checking the accuracy of testing 

equipment and test strips

Medicare 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 100 test strips and lancets every month, and one lancet

device every 6 months.

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

lancets every 3 months, and one lancet device every 6 months. 

If your doctor says it is medically necessary, Medicare will allow 

additional test strips and lancets. “Medically necessary” means that 

services or supplies are needed for the diagnosis or treatment of your 

medical condition and meet accepted standards of medical practice.

If you have questions about diabetes supplies, call 1-800-MEDICARE

(1-800-633-4227). TTY users should call 1-877-486-2048.
8

Section 2: Medicare Part B-covered Diabetes Supplies 

Blood sugar self-testing equipment and supplies

(continued)

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 the following information:

• 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 1 month

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 are an inpatient in a hospital

or skilled nursing facility. If you get your supplies this way, you must

place the order yourself. You will need a prescription from your doctor

to place your order, but your doctor can’t order the supplies for you.

Keep the following in mind:

• You must ask for refills for your supplies.

• You need a new prescription from your doctor for your lancets and

test strips every 12 months.

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 strips, and lancets. If you are getting supplies sent to

you automatically, are getting advertisements that are misleading, or suspect

fraud relating to your diabetes supplies, call 1-800-MEDICARE 

(1-800-633-4227). TTY users should call 1-877-486-2048.

You must get supplies from a pharmacy or supplier that is enrolled in

Medicare. If you go to a pharmacy or supplier that isn’t enrolled in

Medicare, Medicare won’t pay. You will have to pay the entire bill for any

supplies from non-enrolled pharmacies or non-enrolled suppliers.
9

Blood sugar self-testing equipment and supplies 

(continued)

How are the claims paid?

All Medicare-enrolled pharmacies and suppliers must submit claims for

blood sugar (glucose) monitor test strips. You can’t submit a claim for

blood sugar (glucose) monitor test strips yourself. 

You should also make sure that the pharmacy or supplier accepts 

assignment for Medicare-covered supplies. Assignment is an agreement

between you (the person with Medicare), Medicare, and doctors, other

health care suppliers, or providers. This could save you money. If the

pharmacy or supplier accepts assignment, Medicare will pay the pharmacy

or supplier directly. 

You should only pay your coinsurance amount when you get your supply

from a pharmacy or supplier for assigned claims. 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.

Before you get a supply it is important to ask the supplier or pharmacy

the following questions:

• Are you enrolled in Medicare?

• Do you accept assignment?

If the answer to either of these two questions is “no,” you should call 

another supplier or pharmacy in your area who answers “yes” to be sure

your purchase is covered by Medicare, and to save you money. Ask them

the same questions.

If you can’t find a supplier or pharmacy in your area that is enrolled in

Medicare and accepts assignment, you may want to order your supplies

through the mail. This could also save you money.

Section 2: Medicare Part B-covered Diabetes Supplies 
10

Section 2: Medicare Part B-covered Diabetes Supplies 

Insulin pumps

Insulin pumps worn outside the body (external), including the insulin used

with the pump, may be covered for some people with Medicare Part B who

have diabetes and who meet certain conditions. Insulin pumps are considered

to be durable medical equipment. “Durable medical equipment” is certain

medical equipment ordered by your doctor for use in the home.

How do I get an insulin pump?

If you need to use 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 pump. Medicare will also pay for the insulin that is used with the

insulin pump. For more information about durable medical equipment and

diabetes supplies, call 1-800-MEDICARE (1-800-633-4227). TTY users

should call 1-877-486-2048. 

Therapeutic shoes or inserts

If you have Medicare Part B, have diabetes, and meet certain conditions 

(see below), Medicare will cover therapeutic shoes if you need them.

The types of shoes that are covered each year include one of the following:

• One pair of depth-inlay shoes and three 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 two additional pairs of

inserts

Note: In certain cases, Medicare may also cover separate inserts or shoe 

modifications instead of inserts.
11

Section 2: Medicare Part B-covered Diabetes Supplies 

Therapeutic shoes or inserts (continued)

How do I get therapeutic shoes?

In order for Medicare to pay for your therapeutic shoes, the doctor treating

your diabetes must certify that you meet all of the following three conditions:

1. You have diabetes

2. You have at least one of the following 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

• Deformed foot

3. You are being treated under a comprehensive diabetes care plan and need 

therapeutic shoes and/or inserts because of diabetes.

Medicare also requires the following:

• A podiatrist or other qualified doctor prescribes the shoes

• A doctor or other qualified individual like a pedorthist, orthotist, or 

prosthetist fits and provides the shoes
12

Notes: 
13

Section 3: Medicare Part D Diabetes Coverage 3 This section provides information about Medicare Part D (Medicare 

prescription drug coverage) for people with Medicare who have or are at

risk for diabetes. To get Medicare prescription drug coverage, you must join

a Medicare drug plan. For information about Medicare prescription drug

coverage, visit www.medicare.gov/Publications/Pubs/pdf/11109.pdf to view

the booklet “Your Guide to Medicare Prescription Coverage,” or call 

1-800-MEDICARE (1-800-633-4227). TTY users should call 

1-877-486-2048.

The following diabetes drugs and supplies are covered under Medicare

drug plans:

• Insulin. See below.

• Anti-diabetic drugs. See below.

• Diabetes supplies. See page 14.

Insulin

Medicare drug plans cover injectable insulin not used with an insulin

infusion pump. Medicare Part B covers external insulin pumps and the

insulin that the device uses under durable medical equipment.

Anti-diabetic drugs

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

anti-diabetic drugs. Medicare drug plans can cover anti-diabetic drugs

such as the following:

• Sulfonylureas (such as Glipizide, and Glyburide)

• Biguanides (such as metformin)

• Thiazolidinediones (such as Starlix® and Prandin®)

• Alpha glucosidase inhibitors (such as Precose®)
14

Diabetes supplies

Supplies used when you inject or inhale insulin may be covered for all

people with Medicare Part D who have diabetes. These medical supplies

include the following:

• Syringes

• Needles

• Alcohol swabs

• Gauze

• Inhaled insulin devices

For more information 

To get more information about Medicare prescription drug coverage, you

can do any of the following:

• Visit www.medicare.gov and select “Compare Medicare Prescription Drug

Plans,” or view the “Your Guide to Medicare Prescription Drug

Coverage” booklet. 

• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 

1-877-486-2048. 

• Call your State Health Insurance Assistance Program (SHIP). To get their

telephone number, call 1-800-MEDICARE or visit www.medicare.gov

and select “Find Helpful Phone Numbers and Websites.”

Section 3: Medicare Part D Diabetes Coverage
15

4 Section 4: Medicare-covered Diabetes Services

All of the diabetes services listed in this section are covered by Medicare

Part B (Medical Insurance) unless otherwise noted.

For people with diabetes, Medicare covers certain services. Your doctor

must write an order or referral for you to get these services. Once your

doctor writes this order, you should get the services as soon as possible. You

need to make sure you have your doctor’s written order before you get the

services. These services include the following:

• Diabetes screenings. See below and page 16.

• Diabetes self-management training. See pages 16–18.

• Medical nutrition therapy services. See page 19.

• Hemoglobin A1c tests. See page 20.

• Special eye exams. See page 20.

You can get some Medicare-covered services without a written order or

referral. These services include the following:

• Foot exams and treatment. See page 20.

• Glaucoma tests. See page 20.

• Flu and pneumococcal shots. See page 20.

• Physical exam (“Welcome to Medicare” physical exam). See page 21. 

Diabetes screenings

Medicare pays for diabetes screening tests if you are at risk for diabetes.

These tests are used to detect diabetes early. Some of the conditions that

may qualify you as being at risk for diabetes include the following: 

• High blood pressure

• Dyslipidemia (history of abnormal cholesterol and triglyceride levels)

• Obesity (with certain conditions)

• Impaired glucose (blood sugar) tolerance

• High fasting glucose (blood sugar)
16

Diabetes screenings (continued)

Medicare will pay for 2 diabetes screening tests in a 12-month period. After

the initial diabetes screening test, your doctor will determine when to do the

second test. Diabetes screening tests that are covered include the 

following:

• Fasting blood sugar tests

• Other 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 diabetes screening tests that Medicare will cover.

Diabetes self-management training

Diabetes self-management training helps you learn how to successfully 

manage your diabetes. Your doctor must prescribe this training for Medicare

to cover it.

You can get diabetes self-management training if you meet 1 of the 

following conditions during the last 12 months:

• You were diagnosed with diabetes

• You changed from taking no diabetes medication to taking diabetes 

medication, or from oral diabetes medication to insulin

• You have diabetes and have recently become eligible for Medicare

• You’re at risk for complications from diabetes (see below)

Your doctor may consider you at increased risk if you have any of the 

following:

• Have problems controlling your blood sugar, have been treated in an 

emergency room, or have stayed overnight in a hospital because of your

diabetes 

• Been diagnosed with eye disease related to diabetes

• Have a lack of feeling in your feet or some other foot problems like

ulcers, deformities, or have had an amputation

• Been diagnosed with kidney disease related to diabetes

Section 4: Medicare-covered Diabetes Services
17

Section 4: Medicare-covered Diabetes Services

Diabetes self-management training (continued)

Your doctor will usually give you information about where to get diabetes

self-management training. You must get this training from a certified 

diabetes self-management education program as part of a plan of care 

prepared by your doctor or qualified non-doctor practitioner. These 

programs are certified by the American Diabetes Association or the Indian

Health Service.

Classes are taught by health care providers who have special training in 

diabetes education. You are covered to get a total of 10 hours of initial

training within a continuous 12-month period, and 2 hours of follow-up

training each year after that. One of the hours can be given on a 

one-on-one basis. The other 9 hours of training are given in a group class.

The initial training must be completed no more than 12 months from the

time you start the training.

Important: Your doctor may prescribe 10 hours of individual training if

you are blind or deaf, have language limitations, or if no group classes have

been available within 2 months of your doctor’s order.

To be eligible for 2 more hours of follow-up training each year after the

year you received initial training, you must get another written order from

your doctor. The 2 hours of follow-up training can be with a group, or you

may have one-on-one sessions. Remember, your doctor must prescribe this

follow-up training each year for Medicare to cover it.

Note: If you live in a rural area, you may be able to get diabetes 

self-management training in a Federally Qualified Health Center (FQHC). For

more information about FQHCs, visit www.cms.hhs.gov/center/fqhc.asp or

call 1-800-MEDICARE (1-800-633-4227). TTY users should call 

1-877-486-2048.

FQHCs are special health centers, usually located in urban or rural areas.

They can give routine health care at a lower cost. Some types of FQHCs

are Community Health Centers, Tribal FQHC Clinics, Certified Rural

Health Clinics, Migrant Health Centers, and Health Care for the

Homeless Programs.
18

Section 4: Medicare-covered Diabetes Services

Diabetes self-management training (continued)

What will I learn in this training?

You will learn how to successfully manage your diabetes. This will include

information on self-care and lifestyle changes. The first session is an 

individual assessment to help the instructors better understand your needs.

Classroom training will cover topics such as the following:

• General information about diabetes, the benefits 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 is 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 affect blood sugar

• Behavior changes, goal setting, risk reduction, and problem solving

• How to adjust emotionally to having diabetes

• Family involvement and support

• The use of the health care system and community resources
19

Section 4: Medicare-covered Diabetes Services

Medical nutrition therapy services 

In addition to diabetes self-management training, medical nutrition 

therapy services are also covered for people with diabetes or renal 

disease. To be eligible for this service, your fasting blood sugar has to meet

certain criteria. Also, your doctor must prescribe these services for you.

These services can be given by a registered dietitian or certain nutrition

professionals. The services include the following:

• 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 affect your diabetes

• Follow-up visits to check on your progress in managing your diet

Medicare covers 3 hours of one-on-one medical nutrition therapy 

services the first year you receive the service, and 2 hours of follow-up

each year after that. If your doctor determines there is a change in your

diagnosis or medical condition that makes a change in your diet 

necessary, you may be able to get additional hours of medical nutrition

therapy services.

Remember, your doctor must prescribe medical nutrition therapy 

services each year for Medicare to pay for the service.

Note: If you live in a rural area, you may be able to get medical 

nutrition therapy services in a Federally Qualified Health Center

(FQHC). For more information about FQHCs, visit

www.cms.hhs.gov/center/fqhc.asp or call 1-800-MEDICARE 

(1-800-633-4227). TTY users should call 1-877-486-2048.
20

Section 4: Medicare-covered Diabetes Services

Foot exams and treatment 

If you have diabetes-related nerve damage in either of your feet, Medicare

will cover one foot exam every 6 months by a podiatrist or other foot care

specialist, unless you have seen a foot care specialist for some other foot

problem during the past 6 months. Medicare may cover more frequent

visits to a foot care specialist if you have 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 physician

or diabetes specialist when getting foot care.

Hemoglobin A1c tests

A hemoglobin A1c test is a lab test ordered by your doctor. It measures

how well your blood sugar has been controlled over the past 3 months. 

If you have diabetes, this test is covered if it’s ordered by your doctor. For

more information, call 1-800-MEDICARE (1-800-633-4227). TTY users

should call 1-877-486-2048.

Glaucoma tests

Medicare will pay for you to have your eyes checked for glaucoma once

every 12 months. This test must be done or supervised by an eye doctor

who is legally allowed to give this service in your state.

Special eye exam

People with Medicare who have diabetes can get a special eye exam to

check for eye disease (called a “dilated eye exam”). This exam must be

done by an eye doctor who is legally allowed to provide this service in

your state. The dilated eye exam is recommended once a year.

Flu and pneumococcal shots (vaccinations)

Medicare will pay for you to get a flu shot once a flu season in the fall or

winter. Medicare will also pay for you to get a pneumococcal shot. One

pneumococcal shot may be all you ever need in your lifetime. Ask your

doctor.
21

Section 4: Medicare-covered Diabetes Services

Physical exam (one-time “Welcome to

Medicare” physical exam) 

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

and counseling about preventive services. This includes certain 

screenings, shots, and referrals for other care if needed.

Even though the “Welcome to Medicare” physical exam isn’t a diabetesrelated covered service, it’s a good opportunity to talk with your doctor

about the preventive services you may need, like diabetes screening tests. 

Important: In 2008, you have to get the physical exam within the first 

6 months you had Part B, and the Part B deductible applies. Starting

January 1, 2009, Medicare will cover this exam if you get it within the

first 12 months you have Part B, even if the effective date of your Part B

enrollment begins in 2008. You pay 20% of the Medicare-approved

amount, and the Part B deductible no longer applies. 

Who do I call if I have questions about what Medicare covers?

You should call 1-800-MEDICARE (1-800-633-4227). TTY users

should call 1-877-486-2048.

Supplies and services that aren’t covered by

Medicare

Original Medicare and Medicare drug plans don’t cover everything.

Diabetes supplies and services not covered by Medicare include the 

following:

• Eye exams for glasses (called refraction)

• Orthopedic shoes (shoes for people whose feet are impaired, but intact)

• Routine or yearly physical exams—However, Medicare will cover a 

one-time physical exam within the first 6 months in 2008 (first 12

months in 2009 even if the effective date of your Part B enrollment

begins in 2008) of enrolling in Part B. You may have to pay some costs;

see above.

• Weight loss programs
22

Notes: 
23

5 Section 5: Helpful Tips and Resources

The information below provides information for people with limited

income and resources.

Extra help paying for Medicare prescription

drug coverage

You may qualify for “extra help” (the low-income subsidy) from Medicare

to pay prescription drug costs if you have a yearly income below $15,600

($21,000 for a married person living with a spouse and no other 

dependents) and resources less than $11,990 ($23,970 for a married 

person living with a spouse and no other dependents). These amounts are

for 2008. If you live in Alaska or Hawaii, or pay more than half of the 

living expenses of dependent family members, income limits are higher.

To get answers to your questions about extra help paying for your 

prescription drug costs, call your State Health Insurance Assistance

Program (SHIP). To get their telephone number, visit www.medicare.gov

and select “Helpful Phone Numbers and Websites.” Or, call 

1-800-MEDICARE (1-800-633-4227). TTY users should call 

1-877-486-2048.

State Pharmacy Assistance Programs (SPAPs)

Several states have State Pharmacy Assistance Programs (SPAPs) that help

certain people pay for prescription drugs. Each SPAP makes its own rules

about how to provide drug coverage to its members. Depending on your

state, the SPAP will have different ways of helping you pay your 

prescription drug costs. To find out about the SPAPs in your state, call 

1-800-MEDICARE. Or, call your State Health Insurance Assistance

Program (SHIP).
24

Section 5: Helpful Tips and Resources

You can do many things to control your diabetes. Here are some helpful tips

that can help you stay healthy.

Eating right

• Talk with your doctor about what you eat, how much you eat, 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 how much you should weigh. Your doctor can

talk to you about the different ways to help you reach your weight goal.

Taking medicine

• Take your medicines as directed. Talk with your doctor if you have any

problems.

Exercising

• Be active for a total of 30 minutes most days. Talk with your doctor

about which activities can help you stay active.

Things to check

• Check your blood sugar (glucose) as often as your doctor tells you. You

should record this information in a record book. Show your records to

your doctor.

• Check your feet for cuts, blisters, sores, swelling, redness, or sore 

toenails. It is very important to keep your feet healthy to prevent serious

foot problems.

• Check your blood pressure, often.

• Have your doctor check your cholesterol. 

• If you smoke, you should talk with your doctor about how you can quit.

Medicare will cover smoking cessation (counseling to stop smoking) if

ordered by your doctor.

Using these tips can help you manage your diabetes. You should 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. They are there to help you. You should also talk with your

doctor about your treatment options. You and your doctor can decide what’s

best for you. You can also find out more by contacting the organizations on

the next two pages.
25

Section 5: Helpful Tips and Resources

More information is available to help you make health care choices and decisions

that meet your needs. You can order free booklets, and look at information on

the web. If you don’t have a computer, your local library or senior center may be

able to help you find information.

For more information about diabetes, visit www.medicare.gov and select

“Preventive Services,” then select “Diabetes.” Listed below are additional resources:

American Association of Diabetes Educators (AADE)

www.aadenet.org

1-800-338-3633

American Association of Diabetes Educators

200 W. Madison Street

Suite 800

Chicago, IL 60606

American Dietetic Association (ADA)

www.eatright.org

1-800-877-1600

American Dietetic Association

120 South Riverside Plaza

Suite 2000

Chicago, IL 60606-6995

Centers for Disease Control and Prevention (CDC),

Department of Health and Human Services (DHHS)

www.cdc.gov/diabetes/index.htm

1-877-232-4636

(Inquiries and Publications)

CDC Division of Diabetes Translation

4770 Buford Highway NE, Mailstop K-10

Atlanta, GA 30341-3717

Diabetes Exercise and Sports Association (DESA)

www.diabetes-exercise.org

1-800-898-4322

Diabetes Exercise and Sports Association

8001 Montcastle Drive

Nashville, TN 37221
26

Section 5: Helpful Tips and Resources

Food and Drug Administration (FDA), DHHS

www.fda.gov/diabetes

Healthfinder

www.healthfinder.gov

Indian Health Service

www.ihs.gov/medical/Programs/Diabetes/index.asp

1-505-248-4182

Division of Diabetes Treatment & Prevention

5300 Homestead Road, NE

Albuquerque, NM 87110

Juvenile Diabetes Research Foundation

International (JDRF)

www.jdrf.org

1-800-533-CURE (1-800-533-2873)

Juvenile Diabetes Research Foundation International

120 Wall Street

New York, NY 10005-4001

National Diabetes Education Program (NDEP)

www.ndep.nih.gov

1-888-693-6337

National Diabetes Education Program

One Diabetes Way

Bethesda, MD 20814-9692

National Institute of Diabetes & Digestive &

Kidney Diseases (NIDDK) of the National

Institutes of Health (NIH), DHHS

www.niddk.nih.gov

www.niddk.nih.gov/health/diabetes/ndic.htm (Clearinghouse)

1-800-860-8747 (Clearinghouse)

National Diabetes Information Clearinghouse

1 Information Way

Bethesda, MD 20892-3560
27

Notes: 
U.S. DEPARTMENT OF 

HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

7500 Security Boulevard

Baltimore, Maryland 21244-1850

Official Business

Penalty for Private Use, $300

CMS Publication No.11022

Revised November 2008

• To get this booklet in Spanish, call 1-800-MEDICARE (1-800-633-4227). 

TTY users should call 1-877-486-2048.

• ¿Necesita usted una copia en español? También está disponible en audiocasete. Llame

GRATIS al 1-800-MEDICARE (1-800-633-4227). Las personas que usan TTY

deben llamar al 1-877-486-2048.

This publication was originally developed in

cooperation with the Maryland Association of

Diabetes Educators.