C E N T E R S F O R M E D I C A R E & M E D I C A I D S E R V I C E S

Medicare’s Coverage 

of Diabetes Supplies & 

Services

This official government 

guide has important 

information about:

•	 What’s covered

•	 What’s not covered

•	 Helpful tips to keep you healthy

•	 Where to get more information
The information in this 

booklet was correct when it 

was printed. Changes may 

occur after printing. Visit 

www.medicare.gov, or 

call 1-800-MEDICARE 

(1-800-633-4227) to get the 

most current information. 

TTY users should call 

1-877-486-2048.
3

Table of Contents

Introduction 4

Section 1: Medicare Coverage for Diabetes At-a-Glance 5

Section 2: Medicare Part B-covered Diabetes Supplies 9

Blood sugar self-testing equipment and supplies . . . . . . . . . . . . . . . . . . . . . . . . 10

Insulin pumps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Therapeutic shoes or inserts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Section 3: Medicare Part D Diabetes Coverage 15

Insulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Anti-diabetic drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Diabetes supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

For more information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Section 4: Medicare-covered Diabetes Services 17

Diabetes screenings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Diabetes self-management training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Medical nutrition therapy services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Foot exams and treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Hemoglobin A1c tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Glaucoma tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Flu and pneumococcal shots (vaccinations) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

“Welcome to Medicare” preventive visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Yearly “Wellness” visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Supplies and services that aren’t covered by Medicare . . . . . . . . . . . . . . . . . . . . 23

Section 5: Helpful Tips and Resources 25

Information for people with limited income and resources . . . . . . . . . . . . . . . 26

Tips to help control diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Phone numbers and websites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
4

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 Medicare Part A (Hospital 

Insurance) and/or Part B (Medical Insurance) benefits.

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

Supplement Insurance (Medigap) 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 have 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’re 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.

Before you read the following sections, you should become 

familiar with these terms:

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 may be less than the 

actual amount a doctor or supplier charges. Medicare pays part of this amount 

and you’re responsible for the difference.

C E N T E R S 

F O R M E D I C A R E & 

M E D I C A I D S E R V I C E S
5

SECTION

1

Medicare Coverage for 

Diabetes At-a-Glance 

T he chart on pages 6–8 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 or inhaling insulin. You must have 

Part B to get services and supplies covered under 

Part B. You must be enrolled in a Medicare drug plan 

to get supplies covered under Part D.
6 Section 1: Medicare Coverage for Diabetes At-a-Glance

Supply/service What’s covered You pay

Anti-diabetic 

drugs

See page 16.

Medicare Part D covers anti-diabetic 

drugs for maintaining blood sugar 

(glucose).

Coinsurance or copayment 

Part D deductible may also apply

Diabetes 

screenings

See page 18.

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

Diabetes selfmanagement 

training

See pages 18–20.

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 & 

supplies (Blood 

sugar self-testing 

equipment & 

supplies on page 10).

Part B covers home blood sugar (glucose) 

monitors under durable medical 

equipment and supplies used with 

the equipment, including blood sugar 

(glucose) 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

Diabetes supplies

See page 16.

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
Section 1: Medicare Coverage for Diabetes At-a-Glance 7

Supply/service What’s covered You pay

Flu & 

pneumococcal 

shots 

See page 22.

Flu shot

To help prevent influenza or flu virus. This 

is normally covered only 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. Part B covers this shot.

No coinsurance, copayment, or 

Part B deductible if your doctor 

or health care provider accepts 

assignment

Foot exams & 

treatment

See page 21.

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 Medicare-approved 

amount after the yearly Part B 

deductible

Glaucoma tests

See page 22.

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’re considered high risk for 

glaucoma if you have diabetes, or a family 

history of glaucoma, or are AfricanAmerican and 50 or older, or are Hispanic 

and 65 or older. Tests must be done by an 

eye doctor legally authorized by the state.

20% of the Medicare-approved 

amount after the yearly Part B 

deductible

Insulin

See page 16.

Medicare Part D covers insulin that isn’t 

administered with an insulin pump.

Coinsurance or copayment

Part D deductible may also apply
8 Section 1: Medicare Coverage for Diabetes At-a-Glance

Supply/service What’s covered You pay

Insulin pumps

See page 13.

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 Medicare-approved 

amount after the yearly Part B 

deductible

Medical nutrition 

therapy services

See page 21.

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.

No copayment, coinsurance, or 

Part B deductible if your doctor 

or health care provider accepts 

assignment

Therapeutic 

shoes or inserts

See pages 13.

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 Medicare-approved 

amount after the yearly Part B 

deductible

“Welcome to 

Medicare” 

preventive visit 

See page 22.

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: You must have the visit within the 

first 12 months you have Part B.

No copayment, coinsurance, or 

Part B deductible if your doctor 

or health care provider accepts 

assignment

Yearly “Wellness” 

visit

See page 23.

If you’ve already had Part B for longer 

than 12 months, you can get a yearly 

“Wellness” visit to develop or update a 

personalized prevention plan based on 

your current health and risk factors.

No copayment or coinsurance or 

Part B deductible if your doctor 

or health care provider accepts 

assignment

You’ll have to wait 12 months after 

having a “Welcome to Medicare” 

preventive visit before you can get 

your yearly “Wellness” visit.
9

SECTION

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 Part B. These covered supplies 

include:

•	 Blood sugar self-testing equipment & supplies. 

See pages 10–13.

•	 Insulin pumps. See page 13.

•	 Therapeutic shoes or inserts. See pages 13–14.
10 Section 2: Medicare Part B-covered Diabetes Supplies 

Blood sugar self-testing equipment & supplies

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

covered 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.

If your doctor says it’s medically necessary, Medicare will allow you to get 

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. You may need to keep a 

record that shows how often you’re actually testing yourself.

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

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

NEW: If you live in a Durable Medical Equipment, Prosthetics, Orthotics, and 

Supplies (DMEPOS) competitive bidding area and get your diabetes supplies by 

mail, the amount you pay may change starting in January 2013. From January 

through June 2013, you can get your supplies from any supplier. 

A national mail order program to save you money on diabetic testing supplies 

is scheduled to start in July 2013. When the program starts, you’ll need to use 

a Medicare contract supplier for Medicare to pay for diabetic testing supplies if 

you choose to have the supplies delivered to your home. You’ll also save money 

if you choose to have your products delivered to your home. Medicare will 

provide more information about this program before it starts.
Section 2: Medicare Part B-covered Diabetes Supplies 11

Blood sugar self-testing equipment & 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 this:

•	 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 one 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’re an inpatient in a hospital or skilled nursing facility.

If you get your supplies this way, you must place the order yourself. You’ll 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’re 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’s enrolled in Medicare.

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

won’t pay. You’ll have to pay the entire bill for any supplies from non-enrolled 

pharmacies or non-enrolled suppliers.
12 Section 2: Medicare Part B-covered Diabetes Supplies 

Blood sugar self-testing equipment & supplies (continued)

How are 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 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.

What supplier or pharmacy should I use?

Before you get a supply it’s important to ask the supplier or pharmacy these 

questions:

•	 Are you enrolled in Medicare?

•	 Do you accept assignment?

If the answer to either of these 2 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’s enrolled in Medicare 

and accepts assignment, you may want to order your supplies through the mail.

This may save you money.
Section 2: Medicare Part B-covered Diabetes Supplies 13

Blood sugar self-testing equipment & supplies (continued) 

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’s 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 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 these:

•	 One pair of depth-inlay shoes and 3 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 2 additional pairs of inserts

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

modifications instead of inserts.
14 Section 2: Medicare Part B-covered Diabetes Supplies

Therapeutic shoes or inserts (continued) 

How do I get therapeutic shoes?

For Medicare to pay for your therapeutic shoes, the doctor treating your diabetes 

must certify that you meet these three conditions:

1. You have diabetes.

2. You have at least one of these 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’re being treated under a comprehensive diabetes care plan and need 

therapeutic shoes and/or inserts because of diabetes.

Medicare also requires:

•	 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
15

SECTION

Medicare Part D 

Diabetes Coverage 3

T his 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 or call 1-800-MEDICARE 

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

These diabetes drugs and supplies are covered under 

Medicare drug plans:

•	 Insulin. See page 16.

•	 Anti-diabetic drugs. See page 16.

•	 Certain diabetes supplies. See page 16.
16 Section 3: Medicare Part D Diabetes Coverage

Insulin 

Medicare drug plans cover injectable insulin not used with an insulin infusion 

pump and inhaled insulin.

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 like:

•	 Sulfonylureas (like Glipizide, and Glyburide)

•	 Biguanides (like metformin)

•	 Thiazolidinediones, like Actos® (Pioglitazone), Avandia® (Rosiglitazone), and 

Rezulin® (Troglitazone)

•	 Meglitinides, which are a class of anti-diabetic drug including Starlix® 

(Nateglinide) and Prandin® (Repaglinide)

•	 Alpha glucosidase inhibitors (like Precose®)

Diabetes supplies 

Supplies used when you inject or inhale insulin may be covered for 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/publications.

•	 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 

phone number, visit www.medicare.gov/contacts, or call 1-800-MEDICARE.
17

SECTION

Medicare-covered 

Diabetes Services 4All 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. In 

general, 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:

•	 Diabetes screenings. See page 18.

•	 Diabetes self-management training. See pages 18–20.

•	 Medical nutrition therapy services. See page 21.

•	 Hemoglobin A1c tests. See page 22.

You can get some Medicare-covered services without a written 

order or referral. These services include the following:

•	 Foot exams & treatment. See page 21.

•	 Glaucoma tests. See page 22.

•	 Flu & pneumococcal shots. See page 22.

•	 Preventive visits (“Welcome to Medicare” preventive visit and 

Yearly “Wellness” visit). See pages 22–23.
18 Section 4: Medicare-covered Diabetes Services

Diabetes screenings 

Medicare pays for diabetes screening tests if you’re 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:

• 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)

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:

• 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 Medicare-covered diabetes screening tests.

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 one of these 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 19

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.

How much training is covered?

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

education. You’re 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’re 

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). FQHCs are special 

health centers, usually located in 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. For more information about FQHCs, visit 

www.cms.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

Diabetes self-management training (continued) 

What will I learn in this training?

You’ll learn how to successfully manage your diabetes. This includes 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 like these:

•	 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’s 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
Section 4: Medicare-covered Diabetes Services 21

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 may include these:

•	 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

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.

Foot exams & 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’ve seen a foot care specialist for some other foot problem during the 

past 6 months. Medicare may cover more frequent visits if you’ve 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.
22 Section 4: Medicare-covered Diabetes Services

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 if you’re at risk. This test must be done or supervised by an eye doctor 

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

Flu and pneumococcal shots (vaccinations) 

Medicare will pay for you to get a flu shot generally 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.

“Welcome to Medicare” preventive visit 

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

counseling about preventive services. This includes information about certain 

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

Even though the “Welcome to Medicare” preventive visit isn’t a diabetes-related 

service, it’s a good opportunity to talk with your doctor about the preventive 

services you may need, like diabetes screening tests.

Note: Medicare will cover this visit if you get it within the first 12 months you 

have Part B.
Section 4: Medicare-covered Diabetes Services 23

Yearly “Wellness” visit 

If you’ve had Part B for longer than 12 months, you can get a yearly “wellness” 

visit to develop or update a personalized prevention plan based on your current 

health and risk factors. This includes:

• Review of medical and family history

• A list of current providers and prescriptions

• Height, weight, blood pressure, and other routine measurements

• A screening schedule for appropriate preventive services

• A list of risk factors and treatment options for you

Supplies & services that aren’t covered by Medicare 

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

supplies and services not covered include:

•	 Eye exams for glasses (called refraction)

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

•	 Cosmetic surgery

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

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

1-877-486-2048.
24 Section 4: Medicare-covered Diabetes Services

Notes
25

SECTION

Helpful Tips & 

Resources 5

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 

Internet. 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.
26 Section 5: Helpful Tips & Resources

Information for people with limited income & 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 $16,755 ($22,695 for 

a married person living with a spouse and no other dependents) and resources 

less than $13,070 ($26,120 for a married person living with a spouse and no other 

dependents). These amounts are for 2012. These amounts may change in 2013.

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 phone number, visit www.medicare.gov/contacts, 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 SPAP in your state, call 1-800-MEDICARE or your State Health 

Insurance Assistance Program (SHIP).

Tips to help control diabetes 

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.
Section 5: Helpful Tips & Resources 27

Tips to help control diabetes (continued) 

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’s 

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’re 

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.

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 

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

able to help you find information.
28 Section 5: Helpful Tips & Resources

Phone numbers & websites 

For more information about diabetes, visit www.medicare.gov, or contact the 

organizations listed below:

Centers for Disease Control and Prevention (CDC), 

Department of Health and Human Services (DHHS) 

www.cdc.gov/diabetes

1-800-232-4636

(Inquiries and Publications)

CDC Division of Diabetes Translation

1600 Clifton Road

Atlanta, Georgia 30333

Food and Drug Administration (FDA), DHHS

www.fda.gov/diabetes

Healthfinder

www.healthfinder.gov

Indian Health Service

www.ihs.gov/MedicalPrograms/Diabetes

1-505-248-4182

Division of Diabetes Treatment & Prevention

5300 Homestead Road, NE

Albuquerque, New Mexico 87110
Section 5: Helpful Tips & Resources 29

Phone numbers & websites (continued) 

National Diabetes Education Program (NDEP)

www.ndep.nih.gov

1-888-693-6337

National Diabetes Education Program

One Diabetes Way

Bethesda, Maryland 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, Maryland 20892-3560
30 Section 5: Helpful Tips and Resources

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 Product No. 11022

Revised August 2012

Medicare’s Coverage of Diabetes Supplies & Services

■ www.medicare.gov 

■ 1-800-MEDICARE (1-800-633-4227) 

■ TTY: 1-877-486-2048 

¿ Necesita usted una copia en español? 

Llame GRATIS al 1-800-MEDICARE (1-800-633-4227).