Medicare and diabetes in Oregon

Diabetes is one of the most common chronic conditions among people with Medicare, and its costs come from several directions: insulin and other drugs, testing supplies, education and care for complications. Here's how Medicare covers diabetes for Oregonians.

Insulin: capped each month

• Under Part D, you pay no more than $35 for a month's supply of each covered insulin, and the Part D deductible doesn't apply.
• Insulin used with a traditional insulin pump is covered under Part B as part of the pump benefit, and it's also capped at $35 a month, with no Part B deductible for it.
• Which insulins a plan covers depends on its formulary. NovoLog and Fiasp had Medicare-negotiated prices in 2026. See does Medicare cover insulin in Oregon? and Lantus coverage.

In Oregon, ORS 689.696 lets a pharmacist dispense emergency insulin and supplies if you show evidence of a prior prescription, up to three times a year.

Other diabetes medicines

Non-insulin diabetes drugs are covered by Part D plans according to each plan's formulary. They include metformin, sulfonylureas, SGLT2 inhibitors (such as Jardiance and Farxiga), DPP-4 inhibitors (such as Januvia and Tradjenta) and GLP-1 drugs (such as Ozempic, Trulicity and Mounjaro).

• Negotiated prices: Jardiance, Farxiga and Januvia have had Medicare-negotiated prices since January 1, 2026; Ozempic, Tradjenta and Janumet join on January 1, 2027 (CMS). Your cost still depends on your plan.
• Part D cap: covered Part D drug costs are capped at $2,400 in 2027 ($2,100 in 2026). The Medicare Prescription Payment Plan can spread costs over the year.
• Weight loss: by law, Part D doesn't cover drugs used only for weight loss. See does Medicare cover weight-loss drugs in Oregon?

Drug guides: Jardiance, Farxiga, Januvia, Ozempic, Trulicity and Mounjaro.

Supplies and glucose monitors (Part B)

Part B covers blood sugar monitors, test strips, lancets and control solution as durable medical equipment when your doctor orders them. Continuous glucose monitors (CGMs) and their supplies are covered for people who meet Medicare's rules, such as people who use insulin or have a history of problematic low blood sugar. You pay 20% of the Medicare-approved amount after the Part B deductible ($283 in 2026; CMS announces 2027 amounts in the fall). Use a supplier enrolled in Medicare that accepts assignment. See does Medicare cover diabetic supplies in Oregon?

Self-management training and nutrition therapy

• Diabetes self-management training (DSMT): with a doctor's order, up to 10 hours in the first year (1 hour individual and 9 hours in a group) and up to 2 hours of follow-up each year after. You pay 20% after the Part B deductible.
• Medical nutrition therapy: counseling with a registered dietitian for people with diabetes or kidney disease, with a doctor's referral. You pay nothing if the provider accepts assignment.
• Medicare Diabetes Prevention Program: a once-in-a-lifetime program for people with prediabetes who meet the program's criteria.

Many Oregon hospitals and clinics offer DSMT programs; ask your doctor for a referral to one near you, or ask about telehealth.

Screenings, eye and foot care

• Diabetes screenings: up to 2 each year if you're at risk, at no cost when your provider accepts assignment.
• Eye exams: a yearly exam for diabetic retinopathy by an eye doctor licensed in your state. You pay 20% after the Part B deductible.
• Foot care: a foot exam every 6 months if you have diabetic nerve damage with loss of protective sensation, plus therapeutic shoes or inserts each year for people who qualify.

Choosing a plan with diabetes

• Original Medicare with a Part D plan lets you see any endocrinologist who accepts Medicare. A Medigap policy can pay the 20% coinsurance on supplies, CGMs and visits.
• Medicare Advantage plans use networks; check that your endocrinologist and supply company are covered and how the plan handles CGMs. Some plans are special needs plans for people with diabetes or other chronic conditions, where offered. Medicare Advantage plans may offer extra benefits such as dental, vision, hearing or fitness. Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage.
• Compare drug lists. Formularies differ; enter your exact drugs when you compare. You can check plans for your drugs or request a call from a licensed insurance agent.

Related guides

Sources

• Medicare.gov — Insulin
• Medicare.gov — Blood sugar monitors
• Medicare.gov — Blood sugar test strips
• CMS — Medicare Coverage of Durable Medical Equipment & Other Devices (CGMs)
• Medicare.gov — Diabetes self-management training
• Medicare.gov — Medical nutrition therapy services
• Medicare.gov — Medicare Diabetes Prevention Program
• Medicare.gov — Diabetes screenings
• Medicare.gov — Eye exams (for diabetes)
• Medicare.gov — Therapeutic shoes and inserts
• CMS — Selected drugs and negotiated prices
• ORS 689.696 — Emergency insulin (oregon.public.law)

Frequently asked questions

Medicare in your Oregon county

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