Are Test Strips Covered by Medicare?

Managing diabetes often involves regular blood glucose monitoring to maintain health and prevent complications. Blood glucose test strips are a fundamental component of this daily management, allowing individuals to track their sugar levels accurately. Many people with diabetes rely on Medicare to help cover the costs of these necessary supplies. This article explains the coverage details, eligibility criteria, and cost considerations for these essential diabetes supplies.

Understanding Medicare Coverage for Test Strips

Medicare provides coverage for blood glucose test strips primarily through Medicare Part B, which is medical insurance. These test strips, along with other related items such as blood glucose meters, lancets, lancing devices, and glucose control solutions, are classified as durable medical equipment (DME). This classification means they are considered medical devices used in the home to manage a medical condition. Part B covers these supplies whether or not a person uses insulin to manage their diabetes.

The quantity of test strips covered can vary. For individuals who use insulin, Medicare Part B typically covers up to 300 test strips and 300 lancets every three months. For those who do not use insulin, coverage is generally limited to 100 test strips and 100 lancets every three months. Medicare Part D, which covers prescription drugs, may also be involved for certain diabetes supplies, such as insulin itself or supplies used to administer insulin, if not covered under Part B.

Meeting Eligibility Requirements

To qualify for Medicare coverage of blood glucose test strips, a Medicare beneficiary must meet specific conditions. A formal diagnosis of diabetes is required, and a doctor must prescribe the test strips and other related supplies. This prescription serves as documentation of medical necessity, confirming that the supplies are needed for the diagnosis or treatment of the medical condition.

The doctor’s order must specify the type of device or supplies needed, whether the beneficiary uses insulin, how often testing is recommended, and the quantity of test strips and lancets required monthly. The frequency of testing directly influences the quantity of test strips Medicare will cover. For instance, if a doctor determines that more frequent testing is medically necessary due to specific health needs, Medicare may approve a higher quantity of strips beyond the standard limits. This often involves the doctor providing additional documentation or a medical record showing the testing frequency.

A new prescription is typically required annually to continue receiving covered supplies. Furthermore, these supplies must be obtained from a healthcare provider or supplier that is enrolled in Medicare and accepts Medicare assignment.

Getting Your Test Strips and Managing Costs

Obtaining covered blood glucose test strips involves specific steps. Beneficiaries must acquire their supplies from Durable Medical Equipment (DME) suppliers or pharmacies enrolled in Medicare that accept Medicare assignment. When a supplier accepts assignment, they agree to accept the Medicare-approved amount as full payment. This means they will not charge the beneficiary more than the Medicare deductible and coinsurance. It is important to confirm the supplier is Medicare-enrolled and accepts assignment.

Beneficiaries with Original Medicare (Part A and Part B) typically pay 20% of the Medicare-approved amount for blood glucose test strips after meeting their annual Medicare Part B deductible. This deductible is an out-of-pocket expense paid before Medicare covers its share. Medicare pays the remaining 80%.

For those enrolled in a Medicare Advantage Plan (Part C), coverage for test strips must be at least equivalent to Original Medicare. Medicare Advantage plans are administered by private insurance companies and may have different cost-sharing structures, such as varying deductibles, copayments, or network rules. Contact your specific plan for details on coverage and costs.