Understanding Medicare and Diabetes Coverage
March 30, 2026 | John Demko
Nearly 1 in 3 (29%) of individuals aged 65 and older have diabetes (2023). Being a senior and living with diabetes can be challenging for both your health and your finances. It's essential to understand Medicare and its coverage for diabetes so you can select the right plan for your needs. In this guide, we'll provide information on how Medicare covers diabetic medications and supplies to help you make informed choices.
Medicare and Diabetes: Costs and Coverage
The costs of diabetes can be staggering: On average, people with diagnosed diabetes have medical expenditures approximately 2.3 times higher than those without diabetes.
Diabetes is not something we can innately spot, but a simple blood test will tell if you have the condition. Medicare Part B covers diabetes screenings for individuals at risk, often at no cost if your doctor accepts Medicare.
An initial diagnosis of diabetes can be overwhelming and stressful. Though stress is a part of life, it can make managing diabetes even more difficult. Diabetes is not directly curable, however, one can control the triggers and symptoms.
How Insulin is Covered in Different Scenarios
- Insulin that is self-administered, under a doctor’s prescription and picked up at a pharmacy. This is covered under Medicare Part D.
- Insulin that is pumped with a monitor and an attached pump. The pump is considered Durable Medical Equipment*, and covered under Medicare Part B.
- Insulin is administered by a professional in a clinic setting. This is considered a medically administered drug and is covered under Medicare Part B.
Insulin Costs Under Medicare Part D
In 2023, the Inflation Reduction Act changed coverage rules and on the current program, all Medicare plans with prescription drug coverage now provide plan-formulary insulins at $35 or less for a one-month supply, regardless of the coverage stage. This pricing applies to all Medicare Part D plans and Medicare Advantage plans that include drug coverage. The $35 cap applies regardless of whether or not individuals have met their annual RX deductible.
Learn More About Insulin Coverage Through Medicare Part D
This has greatly impacted millions on Medicare who rely on life-saving medication, making insulin more affordable.
Get Help with Your Medicare and Medication Coverage
Managing diabetes is already a daily commitment; your Medicare coverage shouldn’t make it more complicated. Taking the time to review your options, understand your benefits, and choose a plan that aligns with your care needs can make a meaningful difference in both your health and your budget.
At Twin City Underwriters, our agents are your advocate. We’re here to help you and your loved ones navigate the complexities of Medicare and diabetes coverage. Our team can help you review plan options that cover your medications, diabetic supplies, and preferred providers so you can know that your plan fits your healthcare and budget needs.
Do you have questions about Medicare and diabetes coverage?
Reach out to the experienced Medicare insurance brokers at Twin City Underwriters to learn more and determine your Medicare coverage options.
Sources:
https://diabetes.org/about-diabetes/statistics/about-diabetes https://www.medicare.gov/publications/12172-3-things-to-know-about-medicare-insulin-costs.pdf
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