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Medicare Diabetics

Medicare Diabetes Prevention Program Offers Model For Chronic Care

Medicare Diabetes Prevention Program Offers Model For Chronic Care

Medicare Diabetes Prevention Program Offers Model for Chronic Care The Medicare Diabetes Prevention Program is expanding, offering private payers a model for chronic disease prevention and management. -CMSs Medicare Diabetes Prevention Program (MDPP) aims to address diabetes prevalence within the Medicare program, and may help other payers develop a model for chronic care, based on the MDPPs promising initial results. Diabetes is a pressing concern for CMS because of rising diabetes care costs within Medicare. In 2016, CMS estimated that Medicare spent $45 billion more on caring for members with diabetes than on costs for members without the disease. Nationally, rates of diabetes and prediabetes are high. The CDCs 2017 National Diabetes Statistics Report found that 20.8 percent of the nations 65 and older population has been diagnosed with diabetes and 4.2 percent have undiagnosed diabetes. The report also found that prediabetes affects nearly 23.1 million elderly adults. CMS leaders have high hopes that the early success of the MDPP can be scaled to improve Medicare outcomes and reduce costs, which may guide preventive care efforts in the commercial payer sector. The model first began as a prevention program supported by local and community organizations. CMS piloted the diabetes prevention program (DPP) from 2013 to 2015 through the agencys Health Care Innovation Awards program. The initial program was organized through a partnership between CMS, the YMCA, and other public and private partners. Piloting organizations hired and trained educators to teach classes focused on wellness behaviors such as healthy eating, exercise, and proper medication use. Educators taught a maximum of 24 classes each that reached 7000 Medicare beneficiaries. As a result of the program, 45 Continue reading >>

New Medicare Benefit Aims To Prevent Diabetes

New Medicare Benefit Aims To Prevent Diabetes

New Medicare Benefit Aims to Prevent Diabetes Program teaches participants healthy lifestyle habits by Barbara A. Gabriel, AARP , April 12, 2018|Comments: 0 Major risk factors for diabetes include obesity, a sedentary lifestyle, and often a family history of the disease. En espaol | If youre at risk of becoming one of the more than 25 percent of Americans age 65-plus with diabetes , you may be eligible for the new Medicare Diabetes Prevention Program (MDPP) designed to help prevent prediabetic individuals from developing the disease. During the yearlong program, Medicare pays for prediabetic older adults to meet regularly in groups to learn and encourage one another to maintain healthy diets, good nutrition, and physical activity.For the first six months, participants attend 16 weekly sessions, after which they meet monthly. If participants meet the programs weight-loss goal of at least five percent of their weight,they are invited to attend an additional year of health-maintenance sessions. Held in local, informal settings, such as hospitals, community centers, YMCAs, and even grocery stores, sessions are facilitated by lifestyle coaches certified by the Centers for Disease Control and Prevention (CDC), who teach participants how they can change their lifestyle habits to lower their risk of developing diabetes. Major risk factors for diabetes include obesity, a sedentary lifestyle, and often a family history of the disease. A blood glucose test can determine if you are prediabetic. You are eligible for MDPP if you are enrolled in Medicare Part B, are clinically overweight, and have elevated glucose levels that are not yet high enough to indicate diabetes. Your doctor can help you find a MDPP program near you. The program is based on agroundbreaking National Institutes 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 >>

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 >>

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 >>

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 >>

What Diabetic Services Does Medicare Cover? - Medicare Faqs

What Diabetic Services Does Medicare Cover? - Medicare Faqs

Speak with a licensed insurance agent: Speak with a Licensed Insurance Agent What Diabetic Services Does Medicare Cover? The first fact you need to know is that you must be enrolled in Medicare Part B for Medicare to cover your diabetic services or supplies. If you have a Medicare Advantage plan, youre required to be enrolled in both Medicare Part A and Part B, so as long as you continue paying your Part B monthly premium, you should be covered as described below. If youre not sure whether youre enrolled inMedicare Part B, look at your red, white, and blue Medicare card, or contact your current health insurance provider. Medicare Part B covers the following diabetic services, generally requiring your Medicare-participating doctors order: Diabetes screening:Medicare covers tests to check for diabetes if youre considered at risk for the disease. These screenings may include tests such as a fasting plasma glucose test, or other Medicare-approved tests your doctor may order for you. Medicare may cover these screenings up to twice a year, depending on your risk factors. Diabetes self-management training:For qualified beneficiaries, Medicare offers a training program that teaches you how to manage your diabetes. It includes education about self-monitoring of blood glucose, diet, exercise, and prescription medications. If you meet certain conditions, Medicare may cover 10 hours of initial diabetes self-management training, to be completed within a year, and two hours of follow-up training each following year. A portion of the training is individual, with just you and your health instructor, but most of the training occurs in a group setting. There are exceptions that might qualify you for 10 hours of individual training: if youre blind or deaf, have language limitations, or i 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 >>

April 1 Brings Day One Of The Medicare Diabetes Prevention Program, And Challenges For Health Plans

April 1 Brings Day One Of The Medicare Diabetes Prevention Program, And Challenges For Health Plans

April 1 Brings Day One of the Medicare Diabetes Prevention Program, and Challenges for Health Plans Some Medicare Advantage plans may not be fully ready for the requirements of this history-making preventive service. Sixteen years after a National Institutes of Health study showed it worked, and 2 years after the CMS actuary said it could save millions of dollars, the Medicare Diabetes Prevention Program (DPP) launches today, making history in the way CMS fights a disease that accounts for $1 in every $3 spent in Medicare. First, an evidence-based preventive service will be expanded to all beneficiaries at no cost, which means every Medicare Advantage plan must have a way to offer it to members under CMS rules. Second, community groups with nonclinical providers, such as the Y-USA, can be paid to offer the plan through medical claims instead of grants. The American Journal of Managed Care spoke on Friday with Brenda Schmidt, founder and CEO of Solera Health, a company that serves as an integratorthe only one of its kindto provide technology, regulatory, and support services that will allow community programs, health systems, and Medicare Advantage plans meet CMS requirements. At the same time, Solera touches the consumer, connecting those interested in the DPP with a program best suited to their needs. The company adds Medicare DPP to its network after years of working with commercial plans, community groups, digital providers, and other network participants. Its been a busy time leading up to April 1. Weve been doing a lot of testing, Schmidt said. There are so many new administrative requirements, and new CPT [Current Procedural Terminology] codes. And there were still Medicare Advantage plans calling over the past week, unsure if their steps to meet CMS requirements 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 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 Coverage To Treat Diabetes

Medicare Coverage To Treat Diabetes

Diabetes is a common medical condition in which the body either doesnt make enough insulin or doesnt respond properly to the insulin it makes. A healthy body uses insulin to process sugars, but when there isnt enough insulin in the body, too much sugar stays in your blood. If your blood sugar remains consistently high, your doctor may diagnose you with diabetes. The information contained in this article is for informational purposes only. It should never be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition. Medicare Part BandMedicare Part Dgenerally cover the services and supplies needed to control diabetes. Heres a breakdown of how Medicare covers diabetes. Medicare Part B covers the fasting blood glucose test, which is a diabetes screening. Medicare covers two diabetes screenings each year for beneficiaries who are at high risk for diabetes. High risk factors for diabetes include: high blood pressure, history of abnormal cholesterol and triglyceride levels, obesity, or a history of high blood sugar. If diabetes runs in your family, you may also need regular diabetes testing. Your doctor may also recommend services that Medicare doesnt cover. You generally pay nothing for these diabetes tests if your doctor accepts the amount approved by Medicare for the diabetes screening. However, you may have to pay 20% of the amount approved by Medicare for the doctors visit. If your doctor diagnoses you with diabetes, Medicare covers the supplies you need to control your diabetes, including blood sugar testing monitors, blood sugar test strips, lancet devices and lancets, and blood sugar control solutions. Medicare Part B may cover an external insulin pump and insulin Continue reading >>

Medicare Diabetes Prevention Program Enrollment Is Now Open

Medicare Diabetes Prevention Program Enrollment Is Now Open

Medicare Diabetes Prevention Program Enrollment is Now Open by Darlene S. Davis , Amanda Makki , Macy L. Flinchum As of January 1, 2018, the Centers for Medicare & Medicaid Services (CMS) began enrolling suppliers in its new Medicare Diabetes Prevention Program (MDPP). If successfully enrolled prior to April 1, 2018, MDPP suppliers may begin furnishing and billing for services under the MDPP program as of that date. [1]The MDPP model is an expansion of CMSs Center for Medicare and Medicaid Innovation (CMMI) Diabetes Prevention Program (DPP) model tested under the authority of Section 1115A of the Social Security Act. CMS first introduced the MDPP expanded model in its Medicare Physician Fee Schedule (MPFS) final rule for Calendar Year (CY) 2017 (2017 Final Rule). [2]In the MPFS final rule for CY 2018 (2018 Final Rule), CMS finalized additional program guidance and implementation information, including implementing supplier standards and enrollment requirements and establishing payment rates. [3]Recently, CMS released the new enrollment application form [4]for MDPP suppliers and subregulatory guidance on the enrollment process. [5] In the United States, type 2 diabetes affects over 25 percent of individuals age 65 and over, and its prevalence is projected to double for all adults ages 18-79 by 2050 if current trends continue. [6]Given the substantial health care costs expended in treating diabetes and related comorbidities, the goal of the MDPP is to test a method of preventing the onset of type 2 diabetes among Medicare beneficiaries with an indication of prediabetes in hopes of decreasing the incidence rate of type 2 diabetes and ultimately cutting health care costs by creating a healthier population. MDPP seeks to prevent diabetes through a structured behavioral chan 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 >>

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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