Diabetes and Medicare
- Last updated
- October 11, 2026
- Read time
- 6 min
Key points
- About half of people 65 and older (52%) have prediabetes, the Centers for Disease Control and Prevention (CDC) said in 2026.
- In 2026 the Medicare Diabetes Prevention Program costs nothing, and through 2029 you can take it more than once.
- In 2026 the most you pay for covered drugs is $2,100 a year, and insulin is $35 a month or less.
Medicare pays for diabetes care whether you have diabetes or prediabetes. It pays for blood sugar tests, a program to help prevent diabetes, classes, a dietitian, eye and foot exams, supplies and drugs. If your doctor just said your blood sugar is "a little high," you may be wondering what to do first.
Medicare pays for diabetes care if
- You have Part B, the part of Medicare that pays for doctor visits and lab tests.
- Your doctor orders the test, class or supply. You can look for a prevention program yourself.
- You meet the rule for that service in the table below.
Not sure Medicare will pay? Ask anyway, because your doctor's office can check before you start. Or a Pair Team advocate can check with you.
What Medicare pays for (2026)
| Service | Who it is for | What you pay |
|---|---|---|
| Diabetes blood tests (screening) | People at risk, like those with high blood pressure, high cholesterol or obesity | Nothing, up to 2 a year |
| Medicare Diabetes Prevention Program | Prediabetes and a body mass index (BMI) of 25 or more, or 23 if you're Asian | Nothing |
| Diabetes classes (self-management training) | Diabetes, with your doctor's order | 20% after the $283 deductible. Up to 10 hours the first year, 2 hours each year after |
| Dietitian visits (medical nutrition therapy) | Diabetes or kidney disease, with a doctor's referral | Nothing. 3 hours the first year, 2 hours each year after |
| Diabetes eye exam | Diabetes | 20% after the deductible, once a year |
| Glaucoma test | Diabetes | 20% after the deductible, once a year |
| Foot exams and care | Nerve damage in your feet with loss of feeling | 20% after the deductible, every 6 months |
| Supplies, shoes and glucose monitors | Diabetes, with a prescription. Shoes and monitors have extra rules | 20% after the deductible. See diabetes supplies |
| Insulin | People with a Medicare drug plan, or a pump Part B covers | No more than $35 a month for each covered insulin, no deductible |
| Diabetes pills and shots (Part D) | Anyone with a Medicare drug plan | No more than $2,100 a year for covered drugs |
| Care coordination (chronic care management) | 2 or more long-term health problems | 20% after the deductible, each month |
| Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) | Original Medicare with diabetes, or prediabetes plus high cholesterol or extra weight | Most groups charge $0 to $7 a month |
What does Medicare pay for if I have prediabetes?
If you have prediabetes, Medicare pays the full cost of the Medicare Diabetes Prevention Program. A coach helps you change how you eat and move, with a group that has the same goals. It's 16 weekly sessions over 6 months, then 6 monthly ones. You can join in person, live online or online at your own pace, Medicare.gov says.
To qualify, you need an A1C of 5.7% to 6.4% or a fasting blood sugar of 110 to 125. The test must be from the last 12 months. You can't have been told you have diabetes or kidney failure. The old once-in-a-lifetime limit is lifted through 2029, a 2026 law says.
For the 2 free blood tests a year, one risk factor like high blood pressure is enough. Two of these also count: being 65 or older, being overweight, or a parent or sibling with diabetes. For other weight help, see weight loss and Medicare.
What does Medicare pay for after a diabetes diagnosis?
After a diagnosis, Medicare pays for classes that teach you to check your blood sugar, take your medicine and plan meals.
Diabetes can hurt your kidneys, and 38% of adults with diabetes have kidney disease, CDC said in 2026. Ask how often to test your kidneys. See kidney disease and Medicare. For meters, strips and sensors, see diabetes supplies and continuous glucose monitors.
What will diabetes medicines cost in 2026 and 2027?
In 2026 the most you pay for covered drugs, including diabetes pills and shots, is $2,100, and in 2027 it's $2,400. Januvia, Jardiance and Farxiga have had prices Medicare set since January 1, 2026, the Centers for Medicare & Medicaid Services (CMS) says. If your plan charges a percent of the price, your share may be lower.
On January 1, 2027, Ozempic, Rybelsus, Janumet and Tradjenta get prices Medicare set, too. NovoLog and Fiasp leave that list at the same time, but the $35 insulin cap stays. If money is tight, apply for Extra Help. In 2026 it caps your copays at $5.10 for generics and $12.65 for brand-name drugs.
Can Medicare help me manage diabetes at home?
Yes, Medicare can help you manage diabetes at home in two ways. With 2 or more long-term health problems, your doctor's office may offer chronic care management. You get a care plan, a review of your medicines and help between visits.
Medicare also has a newer option called ACCESS. It's for people with Original Medicare who have diabetes, or prediabetes plus high cholesterol or extra weight, CMS rules say. Approved groups offer coaching, apps and video visits, and some lend you a glucose monitor. You can sign up yourself, and most groups charge $0 to $7 a month, Medicare.gov says.
What to do next
- Ask for an A1C test at your yearly wellness visit, since Medicare pays for it if you're at risk.
- If you have prediabetes, find a prevention program with the "Find providers" search on Medicare.gov.
- If you have diabetes, ask for referrals to classes, a dietitian and an eye exam.
- Check your drug plan during Open Enrollment, each fall from October 15 to December 7. Plan changes start January 1.
- Apply for help with costs, since Original Medicare's 20% has no yearly limit. See Medicare Savings Programs.
If you also have Medicaid
With full Medicaid, you get Extra Help on its own, so drug copays stay low. If you're a Qualified Medicare Beneficiary (QMB), no doctor, pharmacy or supplier may bill you for Medicare's 20%. Medicaid may also pay for rides to the doctor. See Medicare and Medicaid together and the rules in California and New York.
What a Pair Team advocate does
Diabetes often comes with high blood pressure and heart disease. This is what we do:
- Book your A1C and kidney tests and your eye exam, and follow up on the results.
- Ask your doctor for the referrals Medicare pays for: diabetes classes, a dietitian, and an eye or foot doctor.
- Help you get your meter or monitor and refills, and call the pharmacy if insulin costs more than $35 a month.
- Help with Extra Help forms, your drug plan check each fall, rides and food.
An advocate is covered by Medicare if you qualify. It takes two minutes to find out.
Check if you qualify for a Pair Team advocate
Frequently asked questions
Does Medicare pay for an A1C test?
Yes, Medicare pays for an A1C test, which shows your average blood sugar over the past few months. If you're at risk, it can be one of your 2 free tests a year. With diabetes, it's a regular lab test, and you usually pay nothing.
Does Medicare pay for Ozempic?
Medicare drug plans pay for Ozempic for type 2 diabetes when it's on your plan's list of covered drugs. For drugs used for weight loss, see weight loss and Medicare.
Does a Medicare Advantage plan cover the same things?
Yes, a Medicare Advantage plan must cover the same diabetes care as Original Medicare. It may ask you to use its own doctors and suppliers, so call the plan first. ACCESS is only for people with Original Medicare.
Does Medicare pay for healthy food?
Medicare doesn't pay for food, but it pays a dietitian to plan meals with you. For help buying food, see food help.
Who can I call with diabetes questions?
You can call the American Diabetes Association at 1-800-342-2383 (1-800-DIABETES). For free help with Medicare costs, call your State Health Insurance Assistance Program (SHIP) at 1-877-839-2675. You can also call 1-800-MEDICARE (1-800-633-4227).
Sources
- Diabetes screenings, Medicare.gov
- Medicare Diabetes Prevention Program, Medicare.gov
- Medicare Diabetes Prevention Program FAQ, CMS
- Diabetes self-management training, Medicare.gov
- Medical nutrition therapy services, Medicare.gov
- Eye exams (for diabetes), Medicare.gov
- Glaucoma screenings, Medicare.gov
- Foot care (for diabetes), Medicare.gov
- Insulin, Medicare.gov
- Chronic care management services, Medicare.gov
- Support for chronic health conditions (ACCESS), Medicare.gov
- ACCESS Model, CMS
- Selected Drugs and Negotiated Prices, CMS
- Negotiated Prices for Initial Price Applicability Year 2027, CMS
- 2026 Medicare Parts A and B Premiums and Deductibles, CMS
- National Diabetes Statistics Report, CDC
- Chronic Kidney Disease in the United States, 2026, CDC
- Extra Help with Medicare prescription drug costs, SSA
- American Diabetes Association
- State Health Insurance Assistance Programs
About the author
Alison Shmerling
Medical Director
Alison Shmerling is Pair Team's Medical Director. Since 2024, she has overseen its nurse practitioners, nurses and care managers.
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