Does Medicare Cover A1C for Diabetes Screening?

An A1C test, also known as a hemoglobin A1C or HbA1c test, measures your average blood sugar level over the past two to three months. This blood test is a standard tool used to assess long-term glucose control, providing a broader picture than daily blood sugar readings. It plays an important role in both detecting undiagnosed diabetes and monitoring the condition in individuals already diagnosed. Medicare offers specific coverage policies for A1C testing, which can vary based on whether the test is for screening or ongoing management.

A1C Screening Coverage Under Medicare Part B

Medicare Part B provides coverage for A1C tests when they are utilized specifically for screening purposes, aiming to identify individuals at risk for developing diabetes or pre-diabetes. This coverage is available for those who do not yet have a confirmed diagnosis of diabetes. Beneficiaries are eligible for up to two A1C screening tests within a 12-month period if a healthcare provider determines they are at risk.

Eligibility for A1C screening tests under Medicare Part B is based on specific risk factors. Coverage applies if an individual has high blood pressure, a history of abnormal cholesterol or triglyceride levels (dyslipidemia), obesity, or a history of elevated blood sugar. Additionally, coverage is extended if two or more of the following conditions apply: being aged 65 or older, being overweight, having a family history of diabetes (in parents or siblings), or having a history of gestational diabetes or delivering a baby weighing over nine pounds.

A1C Testing for Diagnosed Diabetes

For individuals already living with a confirmed diagnosis of diabetes, Medicare Part B also covers A1C tests, but in this context, the purpose shifts from screening to ongoing disease management. The A1C test becomes a vital tool for monitoring blood sugar control and assessing the effectiveness of a patient’s diabetes treatment plan. This regular testing helps healthcare providers make informed decisions about medication adjustments, lifestyle changes, and overall care strategies.

Medicare Part B typically covers A1C tests for diagnosed individuals every 90 days, or approximately four times a year, to ensure consistent monitoring of their condition. More frequent testing may be covered if deemed medically necessary by the treating physician to manage complex or unstable diabetes.

Understanding Your Costs and Related Medicare Benefits

Costs for A1C tests covered by Medicare Part B vary depending on the test’s purpose. For A1C screening tests for at-risk individuals, beneficiaries generally pay $0 out-of-pocket if their healthcare provider accepts Medicare assignment and the eligibility criteria are met.

For A1C tests used to monitor already diagnosed diabetes, the standard Medicare Part B deductible and coinsurance typically apply. After meeting the annual Part B deductible, which is $257 in 2025, beneficiaries are generally responsible for 20% of the Medicare-approved amount for the test.

Medicare offers several other benefits for individuals with diabetes to support comprehensive disease management.

Diabetes Self-Management Training (DSMT)

DSMT is covered, providing education on healthy eating, activity, and medication management, with up to 10 hours of initial training and 2 hours of follow-up annually.

Medical Nutrition Therapy (MNT)

MNT services are also covered for diabetes, including nutritional assessments and counseling, typically at no cost if eligible and a doctor’s referral is provided.

Diabetes Supplies and Equipment

Medicare Part B also covers certain diabetes supplies and equipment. This includes blood glucose meters, test strips, lancets, continuous glucose monitors (CGMs), and non-disposable insulin pumps.

Therapeutic Shoes

One pair of therapeutic shoes and three pairs of inserts are covered annually for qualifying individuals with diabetes and documented foot complications.

For most of these additional benefits, beneficiaries pay 20% coinsurance after meeting the Part B deductible.