Medicare Broker for Diabetics: Finding a Plan That Covers What Your Life Actually Looks Like

Insulin, CGMs, and test strips: what each plan type actually covers

• Original Medicare (Part B): Covers insulin pumps, CGMs (if you use insulin), and diabetes self-management training. Test strips and lancets fall under Part B's durable medical equipment benefit.
• Part D: Covers injectable and inhaled insulin. Under the Inflation Reduction Act, insulin copays are capped at $35/month for Part D enrollees.
• Medicare Advantage: Plans vary widely. Some cover CGMs more broadly. Some restrict test strip brands. I compare formularies plan by plan so you know before you enroll.

CGM denials are one of the most common frustrations I hear about. Medicare Part B requires insulin use for CGM coverage. Some Advantage plans have different criteria. I'll find out which ones.

Plans that cover endocrinologists, podiatrists, and eye exams without referrals

Diabetes doesn't stay in one doctor's office. You need an endocrinologist, a podiatrist checking your feet, and annual dilated eye exams. Original Medicare lets you see any provider who accepts Medicare. Advantage plans use networks.

Before recommending any plan, I verify that your current specialists are in-network. If you prefer PPO-style access without referrals, I'll show you which plans offer that in your area.

The $35 insulin cap and what it actually means for your costs

Since 2023, Medicare Part D plans cap insulin copays at $35 per month's supply. This applies in the deductible phase too. But not every insulin brand is on every plan's formulary at the same tier.

I check your specific insulin against each plan's drug list. The cap helps, but you still need a plan that covers your exact medication without prior authorization delays.

What your daily life looks like matters more than any brochure

You know what it's like to fight with a pharmacy over a refill that should be routine. To get a denial letter for a device your doctor prescribed. To manage a condition that never takes a day off while also trying to figure out which Medicare plan won't make it harder.

That's exactly why working with a broker who gets it makes a real difference. I don't just compare premiums. I look at the full picture of what you actually use.

You manage enough already: let a broker handle the coverage part

You're already tracking carbs, monitoring glucose, scheduling appointments, and managing medications. Sorting through dozens of Medicare plans shouldn't be another thing on your list.

I do the comparison work. You make the final call. No cost to you, ever. Carriers pay me, not you. The plan costs the same either way.