Medicare Diabetes Coverage: What's Covered in 2025

# Medicare Diabetes Coverage: What's Covered in 2025

Diabetes affects millions of people on Medicare. You need to know what Medicare covers for diabetes care, supplies, and medicines. This helps you manage your health and your costs. New changes, like the $35 monthly insulin cap, have made diabetes coverage much better.

!A blood glucose monitor, representing Medicare diabetes coverage

> Quick reference: For a 2026 breakdown of what Original Medicare and Medicare Advantage cover — by Part A, B, and D — see our guide: Medicare Coverage for Diabetes.

The $35 Insulin Cap

> Roughly 54% of beneficiaries have Medicare Advantage, where diabetic supplies and care follow plan rules; the rest use Original Medicare with any Medicare-accepting provider. (Source: CMS / KFF, 2024.)

Starting in 2025, you pay no more than $35 per month for each covered insulin product. This is true no matter which Medicare plan you have. It applies to:

• Part D prescription coverage - insulin you buy at pharmacies
• Part B durable medical equipment - insulin used with pumps
• Medicare Advantage plans - must honor the same cap

This cap saves you a lot. Many people used to pay hundreds of dollars a month for insulin.

Diabetes Supplies Under Part B

Medicare Part B covers diabetes supplies as durable medical equipment (DME). This includes supplies used with insulin pumps and some testing gear:

Covered Under Part B:

• Blood glucose monitors
• Blood glucose test strips
• Lancets and lancet devices
• Glucose control solutions
• Continuous glucose monitors (CGMs)
• Insulin pumps and supplies

Cost: You pay 20% of the Medicare-approved amount. First you must meet the Part B deductible. Be sure to use Medicare-enrolled suppliers. If you don't, Medicare won't cover the items.

Continuous Glucose Monitors (CGMs)

Medicare covers CGMs if you:

• Have diabetes treated with insulin
• Need to check your glucose often
• Meet certain medical rules

Covered CGM brands include Dexcom, FreeStyle Libre, and Medtronic. Your doctor must show that you need it.

Diabetes Medications Under Part D

Beyond insulin, Part D covers other diabetes medicines:

• Metformin and other oral medications
• GLP-1 receptor agonists (Ozempic, Trulicity, and more)
• SGLT2 inhibitors (Jardiance, Farxiga)
• Combination medicines

Important: Starting in 2025, Part D has a new $2,000 yearly cap on your out-of-pocket costs. This helps many people with diabetes who take more than one medicine.

Preventive Care Coverage

Medicare covers diabetes prevention and management:

Diabetes Screening

• Free if you are at risk (high blood pressure, obesity, family history)
• Covered twice a year if you have pre-diabetes

Diabetes Self-Management Training (DSMT)

• Learn to manage your diabetes
• Diet advice
• Learn about your medicines
• Learn how to check your levels

Medical Nutrition Therapy

• A diet check made just for you
• Diet advice from registered dietitians
• Many hours of advice are covered

Diabetes Shoes and Custom Inserts

Medicare Part B covers special shoes if you have diabetes-related foot problems:

• One pair of depth shoes and three pairs of inserts each year
• OR one pair of custom-molded shoes
• Your doctor must prescribe them
• A podiatrist, orthotist, or other qualified provider fits them

Tips for Managing Diabetes Costs on Medicare

1. Use preferred pharmacies - Part D plans cost less at preferred pharmacies 2. Compare Part D plans each year - Drug lists change, so your best plan may change too 3. Ask about Extra Help - This low-income aid can cut your drug costs a lot 4. Use mail-order pharmacy - A 90-day supply often costs less than three 30-day fills 5. Look at Medicare Advantage - Some plans offer extra diabetes benefits

Medicare Diabetes Prevention Program

If you have pre-diabetes, Medicare covers the Diabetes Prevention Program:

• A year-long program to change your habits
• Group coaching sessions
• A focus on healthy eating and exercise
• Proven to lower your diabetes risk

To qualify, you need a blood test that shows pre-diabetes. You also need a BMI of at least 25 (or 23 for Asian Americans).

Questions About Diabetes Coverage?

Our licensed Medicare advisors can help you find the best plan for your diabetes medicines and supplies. We will compare drug lists. We will find plans that keep your out-of-pocket costs low.

Get Your Free Medicare Review

Next steps: Take our 2-minute Medicare plan quiz, book a free Medicare review, or see our Medicare Advantage vs. Supplement comparison.

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.