Frequently Asked Questions About Medicare Diabetes Benefits
Can I get continuous glucose monitor supplies at my local pharmacy?
You can pick up CGM supplies at a retail pharmacy only if that pharmacy is enrolled as a Medicare Part B DME supplier. Many pharmacies only bill Part D, which could lead to claim denials.
Before picking up your sensors, ask the pharmacy staff if they can bill Medicare Part B directly. If they cannot, you must order your sensors through an accredited Medicare mail-order DME supplier.
What if I need more test strips than standard Medicare limits?
Medicare allows exceptions to its standard test strip limits when medically necessary. Your prescribing doctor must submit clinical documentation demonstrating why you need to test your blood sugar more frequently.
Keep a daily testing log to share with your provider. Your doctor submits these records to prove medical necessity to Medicare.
Does the $35 cap apply to oral drugs like Jardiance?
The $35 monthly cap applies strictly to insulin products, not oral diabetes medications. Non-insulin oral drugs like Jardiance and Januvia are covered under standard Part D formulary tiers.
These medications are subject to your plan deductible and coinsurance. However, 2026 negotiated prices help lower out-of-pocket costs until you hit the $2,100 cap.
How does the $2,100 out-of-pocket cap protect my diabetes costs?
The $2,100 cap sets an absolute ceiling on what you spend each calendar year for covered prescription drugs. All Part D deductibles, copayments, and coinsurance count toward this annual limit.
Once your total out-of-pocket prescription expenses hit $2,100 in 2026, your plan pays 100% of covered drug costs. You will pay $0 at the pharmacy counter for the remainder of the year.
HealthyHabits.care is an independent publication and is not connected with or endorsed by the U.S. government or the federal Medicare program. This article is general information, not insurance or legal advice. For free, unbiased help with your coverage, contact your State Health Insurance Assistance Program (SHIP) or call 1-800-MEDICARE.
