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Alleviating The Confusion Over New Changes Around Diabetes Supplies

Alleviating The Confusion Over New Changes Around Diabetes Supplies

The Medicare rules for ordering diabetes supplies through a mail-order pharmacy have changed. Here is the information you need to know to make this transition smoothly. On July 1, a Medicare rule took effect that impacts beneficiaries who get their diabetes testing supplies via mail order. It’s referred to as the Medicare National Mail-Order Program. Under the new ruling, beneficiaries must buy their diabetes supplies, including blood glucose trips, lancets, lancet devices, batteries and control solution, through a list of designated vendors, or Medicare national mail-order contract suppliers. Beneficiaries who pick up their testing supplies from a local pharmacy can still do so, but they need to make sure that the store accepts Medicare "assignment" to avoid higher charges for the supplies. At Joslin Diabetes Center, we are closely monitoring this new program which is intended to be a cost-cutting measure. If you have questions or difficulties navigating the new system, we provided you with additional details to ensure the program is not a disruption to your diabetes care. Who is affected? Medicare beneficiaries in all 50 states, D.C., Puerto Rico, the U.S. Virgin Islands, Guam, and American Samoa, who have Original Medicare, are impacted. These changes do not apply to Medicare Advantage plans (like an HMO or PPO). If you are enrolled in a private plan through Medicare, you can contact your plan to find out which suppliers you can use. How can I get my supplies? If you want diabetes testing supplies delivered to your home, you must use an approved Medicare national mail-order contract supplier in order for Medicare to help pay for the supplies. To find a contract supplier, you can call 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov/supplier. Alternatively, Continue reading >>

Medicare Part B

Medicare Part B

#1 Brand used by Medicare patients OneTouch® test strips are ALWAYS covered on Medicare Part B and $0 with most supplemental health plans.* With their red, white and blue Medicare Part B card alone, your patients pay just $1.66 for a box of 50ct test strips. Continue reading >>

Medicare And Diabetes: What Is Covered?

Medicare And Diabetes: What Is Covered?

Medicare is the federal health insurance program for people age 65 and older as well as people under age 65 with disabilities and those living with End-Stage Renal Disease. Original Medicare, the most common way to receive Medicare is comprised of part A and part B. Part A is hospital insurance and will cover most medically necessary hospital, home health, skilled nursing facility, and, hospice care. Part B is medical insurance paid for by a monthly premium and covers most medically necessary doctors’ services, durable medical equipment, preventive care, hospital outpatient services, lab tests, x-rays, mental health care, and some home health and ambulance services. You can choose to also get Medicare Part D which is prescription drug insurance and is provided only through a private insurance company that has a government contract. There is also the alternative option to get a private Medicare plan called a Medicare Advantage Plan or Medicare Part C, which generally includes Part D coverage. The Medicare Plan A deductible for 2017 is $1,316 and depending on how long your stay is, you may have to pay an additional amount. The Plan B monthly premium for most Americans in 2017 is $109, though people pay more depending on income level. You can find out your monthly premium by calling Social Security at 1-800-772-1213. You may also have to pay a deductible for Part B. In 2017 the Part B deductible is $183 and after you pay the deductible Medicare pays 80 percent of the Medicare-approved cost of your medically necessary supplies and services. You would pay the 20 percent coinsurance payment. Once the deductible has been met, you cannot be charged to pay more than your 20 percent coinsurance amount and this is the case whether you pick up your diabetes supplies at a local st Continue reading >>

Diabetes Screenings And Supplies

Diabetes Screenings And Supplies

Create your free Medicare Interactive profile, and receive the following great benefits: Bookmark your favorite courses and answers for quick reference, whether counseling a client, helping a family member, or simply brushing up on your Medicare knowledge Receive a free exclusive resource: the New to Medicare Guide Keep track of where you left off in MI Pro courses, and complete coursework at your own pace Become part of a Medicare community and receive key Medicare reminders Receive updates about Medicare Interactive and special discounts for MI Pro courses, webinars, and more Diabetes is a disease that results in high levels of sugar (glucose) in your blood. Diabetes screenings and supplies can help identify, manage, and treat diabetes. Medicare Part B covers an annual diabetes screening, including a fasting blood glucose test and/or a post-glucose challenge test, if you have one of the following risk factors: History of abnormal cholesterol levels (dyslipidemia) Part B also covers an annual diabetes screening if at least two of the following apply to you: Your family has a history of diabetes during pregnancy (gestational diabetes), or you have had a baby weighing nine pounds or more If you have been diagnosed with pre-diabetes, Medicare covers two diabetes screening tests each year. Having pre-diabetes means you have blood glucose levels that are higher than normal, but not high enough to be classified as diabetes. If you qualify, Original Medicare covers diabetes screenings at 100% of the Medicare-approved amount when you receive the service from a participating provider . This means you pay nothing (no deductible or coinsurance). Medicare Advantage Plans are required to cover diabetes screenings without applying deductibles, copayments, or coinsurance when you se Continue reading >>

How Medicare Covers Diabetes

How Medicare Covers Diabetes

Dear Savvy Senior: What does Medicare cover when it comes to diabetes? I’m 65 and have pre-diabetes, and would like to find out what all is covered. — Fat Albert Dear Albert: Medicare actually offers a wide range of coverage to help beneficiaries who have diabetes, as well as those who are at risk of getting it — but they don’t cover everything. Here’s a breakdown of what Medicare covers when it comes to diabetes services and supplies along with some other tips that can help you save. Doctor’s services: If you’re a Medicare beneficiary, Medicare Part B will pay 80 percent of the cost of all doctor’s office visits that are related to diabetes. You are responsible for paying the remaining 20 percent after you’ve met your annual 2013 $147 Part B deductible. Screenings: If you don’t currently have diabetes, but you do have pre-diabetes or some other health conditions that put you at risk of getting it — such as high blood pressure, high cholesterol and triglycerides, are overweight, or have a family history of diabetes — Medicare will pay 100 percent of the cost of up to two diabetes screenings every year. Education: If you have diabetes, Medicare covers 80 percent of the cost of self-management training (after you meet your Part B deductible) to teach you how to successfully manage your diabetes. Supplies and medications: Eighty percent of the cost of glucose monitors, test strips and lancets (100 per month if you use insulin, or 33 per month if you don’t), glucose control solutions and insulin (if you use an insulin pump) are covered by Medicare Part B, after you’ve met your deductible. If, however, you inject insulin with a syringe, Medicare’s Part D prescription drug benefit may help pay your insulin costs and the supplies needed to inject Continue reading >>

Making The Switch To Medicare With Diabetes

Making The Switch To Medicare With Diabetes

By Pearl Subramanian and Jeemin Kwon From enrolling in the four types of plans to what they cover, everything you need to know when making the switch to Medicare with diabetes Despite covering 58 million Americans in 2017, Medicare can be difficult to navigate. The US-government-run program provides health coverage to people over the age of 65 and to those under 65 who have certain disabilities or other conditions. If you are ready to make the switch over to Medicare or know someone who is, this article is a guide on what you need to know for as smooth a transition as possible, understanding that there are plenty of complexities here! Click to jump to a section: About Medicare Though Medicare is often thought of as one big plan, it actually has four different types of coverage: Part A covers hospital stays, care in nursing facilities, hospice care, and home health care. Part B covers doctors’ services, non-hospital (outpatient) care, some medical devices and preventative services. People pay a monthly premium for this coverage. Part C allows people the option to enroll in private insurance plans (HMOs and PPOs) and to receive their benefits under Parts A and B. Those plans are called Medicare Advantage and some offer additional benefits such as dental and vision. Part D covers prescription drugs and is voluntary. For more information on decoding and understanding health insurance language, check out diaTribe’s guide here. Medicare and Diabetes Medicare covers certain benefits and supplies specific to people with diabetes, including diabetes drugs, blood glucose monitoring equipment, insulin delivery devices, and therapeutic shoes/inserts. Refer to Medicare and Diabetes Coverage for additional information regarding these provisions, and see the table below to learn w Continue reading >>

Medicare’s National Mail Order Program For Diabetic Testing Supplies

Medicare’s National Mail Order Program For Diabetic Testing Supplies

On July 1, 2013, Medicare Part B will implement a national mail-order competitive bidding program specifically for diabetic testing supplies. [1],[2] The program applies to all zip codes in the 50 United States, the District of Columbia, Puerto Rico, U.S. Virgin Islands, Guam and American Samoa.[3] Once implemented, beneficiaries in traditional Medicare[4] will purchase diabetic testing supplies using a mail order option or a non-mail order option.[5] Included Supplies Equipment such as blood glucose test strips, lancet devices, lancet, and glucose control solutions for checking the accuracy of testing equipment and test strips and other Medicare Part B covered diabetic testing supplies are included in the national mail-order program.[6] However, Medicare Part D-covered supplies such as syringes, needles and inhaled insulin devices are not included in the national mail-order program.[7] Mail-Order Options Under the national mail-order competitive bid program, traditional Medicare beneficiaries will purchase their diabetic testing supplies through a national mail-order contract supplier ("Mail Order Option") or in person from any Medicare-enrolled supplier of non-Medicare testing supplies ("Non-Mail Order Option"). [8] Mail-order supplies will be shipped directly from the supplier to the beneficiary through a service such as United States Postal Service, Federal Express, the United Parcel Service or a mail-order contract supplier's delivery service.[9] Beneficiaries can find suppliers at Medicare Part B will reimburse mail-order deliveries provided that they are delivered directly from the supplier to a beneficiary's residence.[10] Beneficiaries who select the Mail-Order Option cannot have diabetic testing supplies shipped to a pharmacy and then have the pharmacy deliver Continue reading >>

Medicare Coverage For Diabetes Services And Supplies

Medicare Coverage For Diabetes Services And Supplies

Diabetes is a condition where your body lacks the ability to use blood glucose (blood sugar) for energy, according to the Centers for Disease Control (CDC). As a result, diabetics may have high blood glucose levels. In diabetics, the pancreas typically doesn’t make or use the insulin hormone efficiently. Your body uses insulin to turn sugar (glucose) into energy. Unused sugar can build up in your blood and cause both short-term and long-term problems. Diabetes can be diagnosed with a simple blood test. Many older Americans have type 2 diabetes, where your body doesn’t produce enough insulin or develops resistance to it, according to the CDC. However, even adults can get type 1 diabetes, which used to be called juvenile diabetes. Medicare covers certain medical services and supplies for individuals who have diabetes or at risk for this condition. Medicare coverage for diabetes screenings If you have Medicare and your doctor considers you at risk for diabetes, you may be eligible for up to two blood sugar screenings per year under Medicare Part B ; you don’t pay anything for the screening itself if you use a Medicare-assigned provider at a Medicare-approved facility. However, you may have to pay 20% of the Medicare-approved amount for the visit to the doctor’s office. Risk factors that may qualify you for a Medicare-covered diabetes screening include: High blood pressure History of abnormal cholesterol and triglyceride levels Obesity History of high blood sugar Family history of diabetes Older age (risk for type 2 diabetes increases with age) Reduced blood sugar tolerance High blood sugar levels when fasting Medicare coverage for diabetes patients If you’re diagnosed with diabetes, Medicare may cover services and supplies you will need to treat and control diabe Continue reading >>

Medicare And Diabetes

Medicare And Diabetes

Diabetes is a health condition that affects millions of Americans, including many Medicare beneficiaries. It’s also a condition that sometimes requires a lot of monitoring, so coverage is important when it comes to Medicare and Diabetes. Fortunately, Medicare offers robust coverage related to diabetes, especially when paired with a Medigap plan. Most of the treatment related to diabetes falls under Parts B and D, although Part A will provide hospital coverage for any inpatient stays related to diabetes. In this post, we’ll discuss various aspects of Medicare and Diabetes care. Be sure not to miss my comments below about common billing problems regarding diabetes supplies so you can learn how to avoid them. What Medicare Part B Covers for Diabetes Part B is your outpatient insurance, and it covers a vast array of services for diagnosing and treating diabetes. Let’s break them into sections to make it easier for you to learn. Medicare Screenings and Prevention for Diabetes All people on Medicare get coverage for an initial Welcome to Medicare physical exam. Afterward, they also qualify for an annual wellness visit. During these visits, Medicare Part B will cover preventive screenings, such as the fasting blood glucose test, to people at risk of developing diabetes. Conditions that put you at high risk for diabetes include older age, high blood pressure or cholesterol, obesity, cardiac disease or history of high blood sugar. A family history of diabetes is also considered a risk factor. When your doctor orders a screening test for you, Part B will cover up to two screenings per year. These screenings are covered 100% by Part B. Medicare Part B can also provide screenings for dyslipidemia, impaired glucose tolerance, high fasting glucose, and the very common hemoglobi Continue reading >>

Medicare Plans For People With Diabetes

Medicare Plans For People With Diabetes

Diabetes is a common health issue, especially for Medicare beneficiaries. Regardless of the kind of diabetes you have — Type 1 or Type 2 — Medicare provides many coverage options to help you receive the care, treatment and supplies necessary. This includes coverage of insulin and insulin pumps, diabetic screenings and foot exams, among other needs you may have. In many cases, beneficiaries with diabetes can receive some specialty coverage options that people without it cannot, including covered eye exams, tests and screenings. This is because diabetes can deteriorate eyesight and impact other health conditions rapidly. Medicare’s goal is to ensure doctors can monitor and help alleviate the potential impacts of diabetes. How Original Medicare Covers Diabetic Care and Needs If you choose to stay with Original Medicare instead of enrolling in a Medicare Advantage plan, it is important to understand how Parts A, B and D work together to help with your diabetes. Medicare Part A is hospital insurance, which allows you to receive the care and treatment you need at a hospital or inpatient medical center. Medicare Part A is given to you for free so long as you meet the enrollment requirements. Medicare Part B is also called medical insurance. Part B allows you to get outpatient services from doctors, therapists and nutritionists. You must choose to opt-in to Part B coverage, and it is not free — you will pay a monthly premium for this level of coverage. With diabetes care, Part B will cover doctor’s appointments and services but it does not cover the supplies you need to manage your diabetes. This kind of Medicare coverage will also cover diabetes-related supplies that help you test your blood sugar levels, including glucose test strips and lancets. If you choose not t Continue reading >>

Diabetes Supplies, What Medicare Covers

Diabetes Supplies, What Medicare Covers

HEALTH FEATURE ARCHIVE Diabetes Supplies: What Medicare Covers 1. Self-testing equipment and supplies: Medicare Part B covered diabetes supplies: Coverage for glucose monitors, test strips, and lancets. Who is covered: All people with Medicare who have diabetes (insulin users and non-users). Medicare covers the same supplies for people with diabetes whether or not they use insulin. These include glucose testing monitors, blood glucose test strips, lancet devices and lancets, and glucose control solutions. There may be some limits on supplies or how often you get them. For more information about diabetic supplies, call your Durable Medical Equipment Regional Carrier. How to get your diabetes equipment and supplies: To get your diabetes equipment and supplies under Medicare, you need a prescription from your doctor. The prescription should say: You have been diagnosed with diabetes. How many test strips and lancets you need in a month. What kind of meter you need. For example, if you need a special meter for vision problems, the doctor should say that and state the medical reason why you need a special meter. Whether you use insulin or not. How often you should test your blood sugar. Points to remember: Ask your doctor or health care provider if regular blood sugar testing is right for you. You need a prescription from your doctor to get your diabetes equipment and supplies under Medicare. Learn the correct way to use your blood sugar meter properly. Your pharmacist, doctor, diabetes educator, or another health care provider can help you. Keep track of your blood sugar readings and share them with your doctor or health care provider at regular visits. Do not accept shipments of diabetes equipment and supplies that you did not ask for. 2. Therapeutic shoes: Medicare also c Continue reading >>

Medicare’s National Mail-order Program For Diabetes Testing Supplies

Medicare’s National Mail-order Program For Diabetes Testing Supplies

Medicare has a National Mail-Order Program for diabetes testing supplies (like test strips and lancets). No matter where you live, you'll need to use a Medicare national mail-order contract supplier for Medicare to pay for diabetes testing supplies that are delivered to your home. If you don't want diabetes testing supplies delivered to your home, you can go to any local pharmacy or storefront supplier that's enrolled with Medicare and buy them there. The National Mail-Order Program doesn't require you to change your testing monitor. If you're happy with your current monitor, look for a mail-order contract supplier or local store that can provide the supplies you need for your monitor. If you switch suppliers, you might need to arrange to have your current prescription transferred or get a new prescription for testing supplies from your doctor. Plan ahead before you run out of supplies. How much will I pay if I buy supplies at a store? You'll pay the same amount for diabetes testing supplies whether you buy them at the store or have them delivered to your home. National mail-order contract suppliers can't charge you more than any unmet Part B deductible and 20% coinsurance. Local stores also can't charge more than any unmet Part B deductible and 20% coinsurance if they accept Medicare assignment. Local stores that don't accept assignment may charge you more. If you get your supplies from a local store, check with the store to find out what your payment will be. Find a supplier. The National Mail-Order Program applies to Original Medicare only. If you’re enrolled in a Medicare Advantage Plan (Part C) (like an HMO or PPO), your plan will let you know if your supplier is changing. If you’re not sure, contact your plan. What if I need a specific brand of equipment or su Continue reading >>

Medicare Coverage Of Diabetes

Medicare Coverage Of Diabetes

| Licensed since 2012 Print According to the Centers for Disease Control and Prevention (CDC), about 29 million Americans suffer from diabetes, or approximately 9.3% of the population (all ages in 2012). The Centers for Medicare & Medicaid Services (CMS) says that diabetes is a disease where blood glucose levels are higher than normal. There are many people who don’t know they have diabetes, and Medicare covers screening tests to check if you do. If you have been diagnosed with diabetes and are enrolled in Original Medicare (Part A and Part B), you may have questions about Medicare coverage of diabetes treatment, tests, and supplies. Here’s what you need to know. What diabetes screenings and exams does Medicare cover? Medicare Part B (medical insurance) will cover lab tests to check for diabetes if you have one of the following risk factors: High blood pressure History of abnormal cholesterol and triglyceride levels Obesity History of high blood sugar Also, Part B will cover the diabetes screenings if two or more of the following apply to you: Age 65 or older Overweight Family history of diabetes History of gestational diabetes (diabetes during pregnancy), or delivery of a baby who weighs more than nine pounds If your doctor orders a screening test, Medicare Part B will pay for up to two diabetes screenings in a 12-month period and you won’t have to pay anything for these tests. If you’ve been newly diagnosed with diabetes, you may want to consider attending diabetes self-management training, which Medicare Part B helps to cover, to help you manage and cope with diabetes. If you have already been diagnosed with diabetes and have Medicare Part B, Part B covers certain screenings, listed below. You’ll generally need to pay a copayment and for 20% of the Medicare Continue reading >>

Does Medicare Cover Diabetes Supplies?

Does Medicare Cover Diabetes Supplies?

Dear Marci, I have Original Medicare and a stand-alone Part D plan. How will my diabetes supplies and insulin be covered? Dear Blake, This is an important question, as Medicare covers diabetes supplies in different ways depending on what you need. Original Medicare Part B (medical insurance) covers some diabetes supplies, and Medicare Part D (prescription drug benefit) covers others. Specifically, Part B covers certain diabetes supplies as durable medical equipment (DME). This means that you must get a prescription from your doctor and use an appropriate provider. For Original Medicare, this can be a supplier that is part of a competitive bidding program or a Medicare-certified supplier, depending on where you live. Part B covers the following Glucose Blood sugar (glucose) test Lancet devices and lancets Glucose control Therapeutic shoes or inserts Insulin that is used with an insulin pump You pay 20 percent of the cost of the Medicare-approved amount and Medicare pays 80 percent of the cost. If you have questions about durable medical equipment and diabetes supplies, you can call 1-800-MEDICARE for more information, and to find a supplier in your area. Alternatively, if you inject your insulin with a needle, then Part D covers the cost of insulin and the supplies necessary to inject the insulin. This includes syringes, needles, alcohol swabs, and gauze. Your stand-alone Part D plan will also cover other medications to treat your diabetes at home, as long as they are on your plan’s list of covered drugs. Depending on the type of supplies you are using, either Medicare Part B or Part D will cover the cost of the supplies you need. You can speak with your doctor to learn more about your health care needs. – Marci Continue reading >>

Medicare Coverage For Patients With Diabetes

Medicare Coverage For Patients With Diabetes

Go to: DIABETES: RISING MEDICARE POPULATION AND ECONOMIC BURDEN Considered by many to be an emerging pandemic, the increasing prevalence of diabetes in the United States population over the past half-century is a growing concern. According to the Centers for Disease Control (CDC), the total number of individuals reported to have diabetes in the United States has more than doubled from 5.8 million in 1980 to 14.7 million in 2004.1–3 Factors proposed to account for the increase of people in the United States diagnosed with diabetes include changing diagnostic criteria, improved or enhanced detection, increased awareness, growth in minority populations, obesity and lifestyle factors, and decreased mortality.4–6 A major increase in the prevalence and incidence of diabetes has been noted among Medicare beneficiaries age 67 or older. Between 1993 and 2001, the adjusted prevalence of diabetes cases per 1,000 individuals in the elderly Medicare population rose from 145 to 197. The highest prevalence rates were noted among minority groups. Between 1994 and 2001 the adjusted incidence of diabetes in beneficiaries age 67 or older increased 36.9%, from 27/1,000 to 37/1,000.6 By 2050, the number of people with diabetes is expected to increase by 165%, with the greatest increase expected among individuals age 75 or older.7 The economic burden attributed to diabetes has paralleled population trends. According to the American Diabetes Association (ADA), in 2002 direct medical and indirect expenditures attributed to diabetes in the United States were $91.8 billion and $39.8 billion, respectively. Individuals age 65 or older bore the majority of the estimated costs at $47.6 billion. Costs for insulin and delivery supplies, oral agents to lower blood glucose, and other outpatient medi Continue reading >>

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