If you’re managing diabetes, you might be leaving money on the table. Most insurance plans offer comprehensive coverage for diabetic supplies that goes far beyond basic blood sugar testing strips. Yet many people don’t realize the full scope of what their insurance will actually pay for.

The reality is striking: over 38 million people in the United States have diabetes according to the CDC, but many aren’t taking advantage of covered benefits that could save them hundreds of dollars annually while improving their health outcomes.

What Medicare Really Covers (More Than You Think)

Medicare leads the pack when it comes to diabetic supply coverage, and recent changes have made things even better. Medicare Part B covers a range of self-testing supplies as durable medical equipment (DME), including blood glucose monitors, test strips, lancets, and glucose control solutions.

But here’s where it gets interesting: Medicare will cover CGM for any patient treated with insulin as long as the other criteria are met. The continuous glucose monitoring (CGM) coverage expanded significantly in April 2023, removing the old requirement for multiple daily finger sticks. Now, if you use any amount of insulin or have problematic hypoglycemia, you may qualify for a CGM that can cost thousands of dollars without insurance.

Medicare’s Hidden Gem: Therapeutic Shoes

One of the most underused Medicare benefits is therapeutic shoes for people with diabetes-related foot conditions. Medicare Part B will cover therapeutic shoes or inserts if you have diabetes-related foot conditions like nerve damage or poor circulation. This benefit can save you $200-400 annually on specialized footwear.

Insulin Cost Cap: A Real Game-Changer

Here’s something that directly impacts your budget: your monthly insulin costs under Medicare Part D or a Medicare Advantage plan that includes prescription drug coverage (MAPD) is $35, and you won’t need to pay a deductible. This cap applies whether you’re using traditional injection methods or an insulin pump.

Private Insurance and State Mandates: Know Your Rights

Most states mandate coverage of diabetes monitoring devices and related supplies, which means your private insurance likely covers more than the basics. Many people can access newer technology like continuous glucose monitors, with most FreeStyle Libre users with private insurance paying less than $40 monthly for sensors.

What to Ask Your Insurance Company

When reviewing your coverage, don’t just ask about test strips. Ask specifically about:

• Continuous glucose monitors and supplies

• Insulin pumps and related equipment

• Diabetes self-management education programs

• Therapeutic shoes or orthotic inserts

• Blood glucose control solutions

Medicaid Coverage: Expanding but Inconsistent

Medicaid coverage varies significantly by state, but the trend is toward expansion. As of May 2023, 45 states and D.C. provide some level of CGM coverage, though eligibility requirements differ. Most states cover some or all of the following supplies: blood glucose control and calibration solutions along with standard testing equipment.

The challenge with Medicaid is that even for the green states above, many people on Medicaid do not have access to a CGM because they do not meet state eligibility requirements. However, if you do qualify, the out-of-pocket costs are typically very low.

Marketplace Plans: Essential Health Benefits Include Diabetes Care

If you buy insurance through the Health Insurance Marketplace, you’re in good shape. Health insurance sold in the Marketplace must at least cover a set of “essential health benefits.” This includes chronic disease management, which encompasses diabetes care and supplies.

Smart Money-Saving Strategies

Use Your Health Savings Account or FSA

If you have a health savings account (HSA) or flexible spending account (FSA), you can use those funds to pay your out-of-pocket costs for a diabetes monitoring device and related supplies that aren’t covered by your insurance plan. This turns your diabetes expenses into pre-tax savings.

Don’t Overlook Manufacturer Programs

Even with insurance, manufacturer discount programs can reduce your costs further. Several glucometer manufacturers offer free or low-cost diabetes supplies through manufacturer programs. These programs often work alongside your insurance coverage.

Consider Medicare Advantage for Extra Benefits

Medicare Advantage plans, offered by private insurance companies, cover everything included in Part A and Part B and often cover additional services. They may provide enhanced coverage for diabetic supplies, medications, and even wellness programs.

What to Watch Out For

Your insurance may limit you to specific brands or require certain suppliers. Always check your plan’s preferred provider list before making purchases. Many people stick with basic glucose meters when their insurance would cover advanced CGM systems that provide continuous monitoring without finger sticks. Understanding your coverage can significantly reduce out-of-pocket costs while improving diabetes management.