How does the $35 insulin cap work?

Every Medicare Part D plan and Medicare Advantage plan with prescription coverage must charge no more than $35/month for each insulin prescription. This applies from the very first prescription each year — no deductible can apply to insulin. The cap covers all Part D-covered insulins (Humalog, Novolog, Lantus, Tresiba, others). Insulin dispensed through a pump under Part B has separate cost-sharing rules, but pharmacy-filled insulin is universally capped at $35/month.

Are CGMs covered if I have Type 2 diabetes without insulin?

Sometimes, with expanding eligibility. As of 2026, Medicare's CGM coverage criteria primarily focus on diabetics on intensive insulin therapy (multiple daily injections or insulin pump). However, some Type 2 diabetics with severe hypoglycemia history, very poor glucose control, or specific clinical indications can qualify. Discuss with your physician — the coverage criteria continue to expand. If your doctor recommends a CGM, the prescription justification matters for Medicare approval.

What if my MA plan denies my CGM prescription?

Appeal the denial. Medicare Advantage plans must cover CGMs at least as well as Original Medicare. If your MA plan denies CGM coverage but you meet Medicare's clinical criteria, file a Level 1 Plan Redetermination appeal with supporting medical records. See our Medicare Appeals page for the full process. Many CGM denials are overturned on appeal when clinical documentation supports the need.

Are diabetes supplies cheaper through Medicare Advantage or Original Medicare?

Depends on your specific situation. Original Medicare + Medigap typically results in $0 out-of-pocket for diabetes DME (test strips, CGM, pump supplies) — Part B pays 80%, Medigap pays 20%. Medicare Advantage plans have plan-specific copays that may be higher or lower depending on the supply and supplier network. For insulin specifically, both Original Medicare (via Part D) and MA-PD plans cap insulin at $35/month. For most diabetics, the total annual cost differs less than the structure suggests; compare based on your specific supplies and providers.

Does Medicare cover Ozempic, Wegovy, or other GLP-1 drugs for diabetes?

Yes for diabetes treatment — Ozempic, Trulicity, Mounjaro, and other GLP-1 receptor agonists are covered by Part D plans when prescribed for Type 2 diabetes. The same drugs prescribed primarily for weight loss (Wegovy, Zepbound) are generally NOT covered by Medicare. The diagnosis on the prescription matters: 'Type 2 diabetes' typically triggers coverage; 'obesity' or 'weight loss' typically doesn't. Tier placement varies by Part D plan; some plans put these on higher tiers with significant copays even with insurance.

Does Medicare cover the Medicare Diabetes Prevention Program (MDPP)?

Yes. The MDPP is a covered Medicare benefit for beneficiaries at risk of developing Type 2 diabetes (based on specific BMI and blood glucose criteria). The program is a structured behavior-change intervention lasting up to 2 years, focused on weight loss, physical activity, and healthy eating. Available at qualifying providers across Ohio. Free to participating beneficiaries — no cost-sharing required. Ask your primary care provider whether you qualify.

Does Medicare Cover Diabetes Supplies and Care in Ohio? (2026)

On this page

The $35 insulin cap
Continuous glucose monitors (CGMs)
Insulin pumps and supplies
Test strips, lancets, and meters
Diabetes self-management training and nutrition therapy
Diabetic eye exams (annual)
Therapeutic shoes for diabetics
Ohio diabetes resources
Common questions

The $35 insulin cap

One of the most impactful Medicare changes for diabetics: the Inflation Reduction Act of 2022 capped insulin cost-sharing at $35 per month per prescription for all Medicare Part D plans and Medicare Advantage plans with prescription coverage, effective January 1, 2023.

Practical effects:

Maximum out-of-pocket per insulin prescription: $35/month, regardless of the medication's list price.
Applies to ALL Part D-covered insulins: Humalog, Novolog, Lantus, Tresiba, Basaglar, Fiasp, Admelog, others.
No deductible: the $35 cap applies from the first prescription each year — Part D plans cannot charge the deductible amount for insulin.
Insulin pump insulin is also $35/month when filled at a pharmacy as a Part D prescription. When insulin is dispensed by the pump manufacturer through DME under Part B, different cost-sharing applies.

Diabetics who previously paid hundreds of dollars per month for insulin saw their costs drop dramatically when the cap took effect. The cap continues in 2026 and is permanent under current law.

Continuous glucose monitors (CGMs)

Continuous glucose monitors (CGMs) like Dexcom G6/G7, FreeStyle Libre 2/3, and Eversense are increasingly used for diabetes management. Medicare covers CGMs under Part B as durable medical equipment for qualifying patients:

Coverage criteria: Medicare typically covers CGMs for diabetics on intensive insulin therapy (multiple daily injections or insulin pump) who need frequent glucose monitoring. Some non-insulin-using diabetics may qualify depending on clinical justification.
Cost-sharing under Part B: 20% coinsurance after the Part B deductible. Medigap typically covers the 20%.
Supplies covered: CGM sensors (replaced every 10-14 days depending on the device), transmitters (replaced periodically), and the receiver/reader.
Smartphone integration: most modern CGMs work with smartphones; Medicare covers the medical components but not the phone itself.

CGM coverage has expanded significantly

Medicare's CGM coverage has expanded substantially over the last several years. In 2017, only insulin-pump users could get Medicare-covered CGMs. By 2024-2025, coverage was extended to most diabetics on intensive insulin therapy. As of 2026, some non-insulin-using diabetics with severe hypoglycemia history or specific clinical indications can also qualify. If you have Type 2 diabetes and your doctor recommends a CGM, Medicare coverage may be available — discuss the clinical justification with your endocrinologist or primary care.

Insulin pumps and supplies

Insulin pumps are covered under Medicare Part B as durable medical equipment for Type 1 diabetics and some Type 2 diabetics meeting specific clinical criteria:

Pump devices: Medtronic, Tandem t:slim, Omnipod 5, and others. Covered when prescribed for Type 1 diabetes or insulin-requiring Type 2 with documented need.
Pump supplies: infusion sets, reservoirs, and other supplies covered as DME at 20% coinsurance.
Insulin for pumps: when supplied through DME under Part B, follows Part B coinsurance. When filled at a pharmacy as a Part D prescription, the $35/month cap applies.
Hybrid closed-loop systems (combining pump and CGM with automated insulin delivery): covered when components individually qualify under Medicare DME rules.

Test strips, lancets, and meters

Standard blood glucose monitoring supplies are covered:

Blood glucose meters: covered under Part B at 20% coinsurance. Typical Medicare-covered brands include OneTouch, Accu-Chek, FreeStyle, Contour. Some are covered with $0 cost-sharing through specific Medicare-contracted suppliers.
Test strips: covered with quantity limits — typically 100 strips per month for non-insulin-using diabetics and 300 per month for insulin-using diabetics. Higher quantities require documentation of medical necessity.
Lancets: covered alongside test strips.
Control solution: covered as part of test strip benefit.

For Medicare Advantage enrollees, network restrictions may apply — you may need to use specific in-network DME suppliers or mail-order programs for the lowest cost. Original Medicare beneficiaries can use any Medicare-approved DME supplier.

Diabetes self-management training and nutrition therapy

Two preventive services particularly valuable for diabetics:

Diabetes Self-Management Training (DSMT): 10 hours of initial training (group or individual) plus 2 hours of follow-up training annually. Covered when prescribed by a physician and provided by an accredited program. Cost-sharing: 20% coinsurance after the Part B deductible (or $0 with Medigap).
Medical Nutrition Therapy (MNT): 3 hours of one-on-one nutrition counseling in the first year with a registered dietitian or nutrition professional, plus 2 hours follow-up annually. For diabetics and patients with kidney disease, MNT is covered with $0 cost-sharing as a preventive service when provided in an outpatient setting.

These services are underutilized — many Medicare diabetics aren't aware they're covered or don't think to ask. If you're managing diabetes and haven't had recent DSMT or MNT, ask your physician for a referral.

Diabetic eye exams (annual)

Diabetics have elevated risk for diabetic retinopathy, glaucoma, and other vision-threatening conditions. Medicare covers annual diabetic eye exams (dilated retinal examination) for all diabetics:

Coverage: 80% under Part B after the deductible (or $0 with Medigap).
Provider: covered when performed by a state-licensed ophthalmologist or optometrist.
Frequency: once every 12 months.
Importance: diabetic retinopathy is a leading cause of blindness in working-age adults; early detection enables treatment that preserves vision.

Many Medicare Advantage plans cover diabetic eye exams with $0 copay as part of their preventive benefit.

Therapeutic shoes for diabetics

Diabetics with specific foot complications can receive Medicare-covered therapeutic shoes:

Eligibility: diabetic with neuropathy (loss of feeling), poor circulation, foot deformity, history of foot ulcers, history of amputation, or callouses leading to ulcers.
Coverage: one pair of custom-molded shoes plus three pairs of inserts per year, OR one pair of depth-inlay shoes plus three pairs of inserts per year. Modifications and additional pairs may be covered with documentation.
Cost-sharing: 20% coinsurance after the Part B deductible.
Suppliers: Medicare-contracted DME suppliers for therapeutic shoes; some pedorthists and podiatry offices are certified.

Ohio Medicare beneficiary managing diabetes?A licensed Ohio Medicare agent can help you understand whether your current plan optimizes diabetes coverage — particularly insulin cap savings, CGM coverage, and supplemental nutrition benefits. No cost to you.

Find a Medicare Agent in Ohio

Ohio diabetes resources

Beyond Medicare-covered services, Ohio resources for diabetics include:

Ohio Diabetes Network — coordinates diabetes prevention and management resources statewide.
Diabetes Self-Management Education (DSME) programs at major hospital systems (Cleveland Clinic, OSU Wexner, UC Health, Mercy Health, ProMedica, Summa) — all Medicare-accredited.
YMCA Diabetes Prevention Program at participating Ohio YMCAs — for pre-diabetics, often covered by Medicare and most insurance.
Medicare Diabetes Prevention Program (MDPP): a covered Medicare benefit for pre-diabetics (those at risk of developing Type 2 diabetes) — structured behavior-change program available at qualifying providers across Ohio.
American Diabetes Association Ohio — patient education, advocacy, and support resources.