Your Medicare Coverage
Is my test, item, or service covered?
How often is it covered?
Medicare Part B (Medical Insurance) covers screenings to check for diabetes. You may be eligible for 2 diabetes screenings each year.
Part B covers these screenings if your doctor determines you're at risk for diabetes or you're diagnosed with pre-diabetes. These lab tests are covered if you have any of these risk factors:
- High blood pressure (hypertension)
- History of abnormal cholesterol and triglyceride levels (dyslipidemia)
- History of high blood sugar (glucose)
Part B also covers these tests if 2 or more of these apply to you:
- Age 65 or older
- Family history of diabetes (parents, brothers, sisters)
- History of gestational diabetes (diabetes during pregnancy) or delivery of a baby weighing more than 9 pounds
If you have Part B and prediabetes, you may qualify to get diabetes prevention program services. Prediabetes is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as having type 2 diabetes. These services can help you make health behavior changes that can prevent or delay the onset of diabetes. If you qualify, you can get services at no out-of-pocket cost and without a referral from your doctor.
The program begins with at least 16 core sessions over a 6-month period which are offered in a group setting. After the core sessions, additional monthly sessions will help you maintain healthy habits. The diabetes prevention program sessions will include:
- Tips on how to get more exercise
- Strategies for controlling your weight
- Support from people with similar goals and challenges
- A lifestyle coach, specially trained to help keep you motivated
Talk to your doctor to find out if you have prediabetes.
If you’re in a Medicare Advantage Plan, contact your plan for more information.
Your costs in Original Medicare
You pay nothing for these tests if your doctor or other qualified health care provider accepts assignment.
Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.