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Medicare Limitations On Diabetes Supplies Endanger Patients

Medicare Limitations On Diabetes Supplies Endanger Patients

Medicare Limitations on Diabetes Supplies Endanger Patients The Medicare Competitive Bidding Program presents patient safety risks by limiting diabetes testing supply choices, a new survey contends. -Medicares Competitive Bidding Program (CBP) may increase the risk of negative patient safety events or medication nonadherence for diabetics by limiting the variety of available diabetes testing supplies, finds a survey by the American Association of Diabetes Educators (AADE). According to the AADEs research, the number of manufacturers making diabetes testing supplies (DTS) available under the National Mail Order (NMO) system has fallen by 50 percent since the CPBs start in 2009, limiting providers ability to match patients with the best equipment for their needs. Over 65 DTS brands once offered through the NMO are now unavailable. The number of DTS manufacturers offered to Medicare beneficiaries has fallen from 38 to 20. CMS Seeking Feedback on Pediatric Alternative Payment Model Physicians, diabetes educators and other healthcare practitioners often prescribe specific DTS based on the needs of individual patients, along with their experiences with the reliability, performance and features of specific products, the researchers said. For example, some beneficiaries need audible readings or large displays because of poor vision. Providers may recommend DTS that are compatible with their office-based electronic medical record system. Different DTS are not interchangeable. The inability to provide certain brands under Medicare coverage options may increase the risk of diabetes complications, including blindness. Limited options could also push beneficiaries into paying higher costs. When a beneficiary is forced to use a DTS that is unknown, difficult, confusing, or unreliabl Continue reading >>

Prodigy® Diabetic Supplies – Medicare And Insurance Coverage

Prodigy® Diabetic Supplies – Medicare And Insurance Coverage

Blood glucose testing is an important part of diabetes management. Most insurance companies and Medicare/Medicaid will pay for blood glucose testing supplies. With private insurance or managed care, patients will most likely be asked to pay a co-pay to cover part of the cost of the supplies. Medicare pays for 80% of supplies once the patient has met their yearly deductible and the patient is responsible for the remaining 20% of the cost. See the www.Medicare.gov site for a full explanation of how your blood glucose testing supplies are covered. Prodigy Diabetes Care is contracted with certain insurance providers and state Medicaid programs, which may make the Prodigy brand products available to those individuals at a lower co-pay or no co-pay depending on the program. 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 >>

Does Medicare Cover My Diabetic Testing Supplies?

Does Medicare Cover My Diabetic Testing Supplies?

The simple answer is that yes, Medicare does cover some diabetic supplies. Medicare covers diabetic testing supplies, such as: Glucose Test Strips Blood Sugar Testing Monitors Lancets Glucose Solution Avoid the Most Common Pitfalls When Buying Diabetic Supplies Many people who are new to Medicare and/or diabetes care do not realize that in order for diabetic supplies to be covered by Medicare, a prescription is required from your doctor. If you buy diabetic supplies over-the-counter without a prescription, you have to pay full price. In addition, you should purchase your diabetic supplies at the pharmacy counter (as opposed to the general retail counter) because the pharmacy has the ability to process the claim with Medicare. Also, keep in mind that Medicare will not pay for supplies if you go to a pharmacy that is not enrolled in Medicare. The Most Complete Insurance Coverage: Medigap Plan F To ensure that your insurance covers the cost of diabetic supplies, such as diabetic meters, lancets, and test strips, we recommend enrolling in excellent health insurance coverage, which includes: Medicare A & B A good Medicare Part D plan & Medicare supplement Plan F You can protect yourself from against high out-of-pocket costs by enrolling in a full coverage Medicare supplement plan, such as the Medigap Plan F policy, which covers 100% of Medicare Part B’s excess charges. It is the most comprehensive Medicare supplement plan because it covers ALL the gaps left by Medicare A & B. Without a Medicare supplement Plan F, you will most likely be responsible for the Part B deductible ($183 deductible in 2018) and any required coinsurance or copays. You should not be required to pay any out-of-pocket costs if you have Medicare A & B, Medicare Part D, and Medigap Plan F. How to Minimi Continue reading >>

Does Medicare Cover Diabetes Supplies

Does Medicare Cover Diabetes Supplies

| Licensed since 2008 Print Are you looking for ways to manage your costs for diabetes supplies? In addition to any medications your doctor prescribes, like insulin, you also could have costs related to daily blood glucose monitoring. Fortunately, if you are enrolled in Original Medicare (Part A and Part B) or a Medicare Advantage plan, you may have coverage for some of your diabetic supplies and equipment. Here’s a summary of your benefits. Please note that this article refers to Medicare Part B. If you’re enrolled in a Medicare Advantage plan, you still get all the benefits of Medicare Part B (along with Part A benefits, all except for hospice care – which is covered for you under Medicare Part A). If you have questions, contact your Medicare Advantage plan. Does Medicare cover diabetes supplies for blood glucose testing? Diabetic supplies for blood glucose monitoring are considered durable medical equipment (DME) under Medicare Part B. In order for your diabetes supplies to be covered, they must be ordered and supplied by providers who participate in the Medicare program. In addition, in some parts of the country, Medicare has launched a new competitive bidding program for DME to help lower costs for these items. If you live in one of these areas, you must get your diabetic supplies from a contracted provider or Medicare may not pay for them. Part B may pay 80% of allowable charges for glucose monitors, glucose control solution, diabetic test strips, and lancets and lancet devices; you then generally pay 20% plus any applicable deductibles. There may be quantity limits on the number of test strips and lancets Medicare covers each month (usually 300 of each every three months if you use insulin, or 100 of each if you don’t).However, your doctor may request an 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 >>

Have Diabetes? Medicare Parts B And D Have You Covered

Have Diabetes? Medicare Parts B And D Have You Covered

If you have diabetes, you know it’s a day-to-day reality that needs to be attended to. Making wise food choices, eating at regular times and testing your blood glucose are just a few of the self-care behaviors you may need to master. Medicare supports your self-care efforts by providing coverage for diabetes supplies and services. Medicare Part B covers testing and other supplies you may need plus some medical and education services. Medicare Part D covers diabetes medications and supplies for injecting or inhaling insulin. In general, you pay 20% of the Medicare-approved amount for diabetes supplies and services covered by Part B after the yearly deductible is met. Your percentage share of the cost is called coinsurance. You may pay a coinsurance amount or a copayment for items covered by Part D. A co-payment is a small set dollar amount that you pay each time you receive a service or fill a prescription. What you pay depends on the terms of your specific Part D plan. Some services, such as medical nutrition therapy and hemoglobin A1c tests (HbA1c), may be provided at no additional cost to you. Here’s a rundown of the diabetes supplies and services that Medicare covers. Medicare Part B-covered items include: Blood glucose testing supplies and equipment (meters, test strips, lancets and control solutions) Therapeutic shoes or inserts Insulin pumps and insulin used with a pump Diabetes screening tests for people at risk Diabetes self-management training to learn how to help manage diabetes day-to-day Medical nutrition therapy, including diet and lifestyle counseling Hemoglobin A1c tests to monitor blood glucose control Foot exams and treatment for diabetes-related nerve damage Eye test for glaucoma Medicare Part D-covered items include: Medications to manage blood gl 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 >>

What Diabetic Supplies Are Covered By Medicare? - Medicare Faqs

What Diabetic Supplies Are Covered By Medicare? - Medicare Faqs

What Diabetic Supplies Are Covered by Original Medicare? Original Medicare Part B covers some diabetic supplies, including: Blood glucose monitors, lancet devices, and lancets Glucose control solutions for checking the accuracy of test strips and monitors Insulin if you are using a medically necessary insulin pump (see below) There may be coverage limits on the quantity and frequency you can get these supplies. Original Medicare Part B does not cover these diabetic supplies: Insulin (unless used with an insulin pump) If you use a medically necessary external insulin pump, the insulin and the pump could be covered as durable medical equipment (DME). If you do not use a pump, you pay for all of your insulin costs. If you have Medicare prescription drug coverage (Medicare Part D), insulin and certain medical supplies used to inject insulin are covered. Medicare Part B coverage includes therapeutic shoes or inserts fordiabeticswho have certain conditions ask the doctor who treats your diabetes if you need them. To make sure these supplies are covered by Medicare, please note: A qualified doctor (such as a podiatrist) must prescribe the shoes or inserts. A qualified doctor (such as an orthodontist) must provide and fit you for the shoes or inserts. Medicare Part B covers one pair of custom-molded shoes (including inserts) or one pair of depth-inlay shoes per calendar year. Medicare also covers two additional pairs of inserts each calendar year for custom-molded shoes and three pairs of inserts each calendar year for depth-inlay shoes. In certain cases, shoe modifications may be substituted for inserts. The supplier must have an order (prescription) on file signed and dated by the treating doctor; if you switch to a different supplier, you may need to have your prescription 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 >>

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We Use Cookies On This Site To Enhance Your User Experience

When you have diabetes, accuracy matters. Stick with the brand you trust—don't let them switch your test strips! Some test strip suppliers may tell you otherwise, but Accu-Chek products are still covered by Medicare Part B at the same low co-pay1 as all other brands.2 They may even try switching you to another brand. They’re not concerned about you—they’re doing it to benefit their own bottom line. You can take some simple steps to preserve your choice and ensure you’re not switched to a low-quality product: Say "no," if your strip supplier tries to switch you to another brand. At your next visit, ask your doctor to specify Accu-Chek test strips by name on your prescription. Ask for Accu-Chek strips by name from your test strip supplier. If they no longer carry Accu-Chek test strips, you can purchase them from local retail pharmacies. For a list of retailers that offer Accu-Chek products, visit our Where to Buy page. Get smart answers about Medicare changes Medicare has changed how mail-order customers get diabetes testing supplies. Here's what it means for you. What if my mail-order supplier tells me I need to switch to another brand? You do NOT have to change brands. Patient protection rules exist to help ensure that you have access to the supplies you know and prefer to use. The anti-switching rule requires contract suppliers to furnish the brand of testing supplies that work with the monitor currently in use by the patient. It was established to protect patient and physician choice of glucose monitors. If the supplier you contacted doesn't carry Accu-Chek products, visit your local retailer to purchase your Accu-Chek test strips. Am I required to get my strips through mail order? No. Medicare Part B patients can get diabetes testing supplies from a retail Continue reading >>

Improving Medicare Access To Quality Diabetes Supplies

Improving Medicare Access To Quality Diabetes Supplies

We're sorry, an error occurred. We are unable to collect your feedback at this time. However, your feedback is important to us. Please try again later. If you're on Medicare and get your diabetes testing supplies through a mail order pharmacy, you're in luck -- things are about to get a lot better. That is, you'll soon have expanded access to the most accurate devices, and non-generic D-supplies you need and want. Say thanks to Congress, which weaved into a Feb. 9 budget bill very important language to fix a gap in Medicare coverage -- clarifying and strengthening the rules on the distribution of mainstream-brand glucose testing suppliesthrough mail order. And this has implications beyond Medicare, as private insurers often follow suit. To learn more about what's happening, we had a thorough chat with our friend Christel Marchand Aprigliano, who co-founded the Diabetes Patient Advocacy Coalition (DPAC) and has been advocating on this issue for years now. A Talk with Advocate Christel Marchand Aprigliano DM) Hi Christel, can you boil this downfor the layperson: What exactly has happened here? CMA) People with diabetes who are Medicare beneficiaries can nowget access to better quality blood glucose meters and test strips, somethingthat hasnt been possible since the Competitive Bidding Program started in2011. That program interfered with PWDs ability to get what they wanted, allin the name of cost as proclaimed by the Centers for Medicare and MedicaidServices (CMS). Take us back to thestart whats this Competitive Bidding Program all about? It all goes back to 2003. Congress began the Medicare Durable MedicalEquipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive BiddingProgram . Sellers who wished to offer supplies to Medicare beneficiarieswould bid for the p 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 >>

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 >>

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 >>

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