Medicare & Diabetes - What's Covered?
According to the Centers for Disease Control (CDC), there are ~29m people in the U.S. (about 1 in 11) that has diabetes. Check out the entire CDC Diabetes infographic here. For Diabetics going on or already on Medicare, confusion is common. How do I pay for my needles & testing strips? What about the insulin? Is my pump covered? These are just a small sampling of questions that we hear often related to Diabetes & Medicare. Some responses to the FAQs are below. Are my blood testing equipment & supplies covered by Medicare? Testing Strips, Monitors, Lancet Devices & lancets are covered by Medicare Part B. This is good news for individuals who have original Medicare with a decent Medicare Supplement (e.g. Plan F or G) since Medicare will pay 80% of the cost and the Supplement will pay the other 20%. What about my insulin? Medicare drug plans (Part D) cover injectable insulin not used with a pump. Insulin can be very expensive and will most likely result in reaching the Part D donut hole (aka Coverage gap) of Medicare. Find out more about Part D and the Donut hole. What if I take Metformin (or a similar drug) instead of insulin? These drugs are generally covered under Part D. You want to make sure you pick the correct Part D plan when you initially enroll in Part D, and each year during your Open Enrollment (Oct 15 – Dec 7). More information and a short video about the Part D RX analysis can be found here. Is my insulin pump covered? As a general rule, insulin pumps are not covered by Medicare. However, if a doctor provides a prescription indicating the insulin pump is medically necessary, then Part B (and a Medicare Supplement) will cover both the insulin pump and the insulin. Read this: Medicare's Coverage of Diabetes Supplies & Services These are just a few of the FAQs Continue reading >>
Diabetic Supply Provider Wheeling, Insulin Pump, Test Strips, Lancets Mark Drug Medical Supply Wheeling, Il 800-479-6275
Yes, Medicare will cover the cost of some diabetes supplies if you have diabetes. The Medicare will pay for limited amounts of diabetes supplies if you have a medical need for them and they have been prescribed by your treating doctor. To ensure that Medicare pays for your supplies you must follow the steps below: Only your doctor can prescribe diabetes supplies for you, so do not order anything until you have visited your doctor. Your treating doctor must write an order (prescription) for the diabetes supplies, document the need in your medical records and give you a prescription for the supplies. The order must be received by the supplier before Medicare is billed and it must be kept on file by the supplier. If you receive your Medicare through a one of Medicare Medical Advantage Plans (like a HMO, PPO) it is likely you will have to follow the plan's steps for approval and purchase. Make a point of calling your plan's customer service number and ask about their steps for coverage of diabetes supplies. Types of Diabetic Supplies Covered by Medicare Medicare covers some diabetes supplies, including: Glucose control solution for checking the accuracy of test strips and monitors. There may be limits on how much or how often you get these supplies; The limits will vary with the type of coverage you have (Part B cover, Medicare Advantage Plan). Medicare Part B does not cover the cost of insulin unless you use an Insulin pump. If you inject your insulin with a needle (syringe), the Medicare prescription drug benefit (Part D) covers the insulin and the supplies necessary to inject it:, which includes: syringes, needles, alcohol swabs and gauze. Your Part D plan will cover the insulin and any other medications to treat your diabetes at home as long as they are on your plan's Continue reading >>
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 >>
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 Original Medicare?
Original Medicare Part B covers some diabetic supplies, including: Blood sugar (glucose) test strips 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) Therapeutic shoes or inserts (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) Insulin pens, syringes, or needles Alcohol swabs or gauze About insulin coverage 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. About therapeutic shoes and inserts Medicare Part B coverage includes therapeutic shoes or inserts for diabetics who 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 (pr Continue reading >>
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 >>
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 >>
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 >>
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 >>
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 >>
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 Diabetic Testing Supplies
On July 1, 2013, Medicare Part B will implement a national mail-order competitive bidding program specifically for diabetic testing supplies. , 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. Once implemented, beneficiaries in traditional Medicare will purchase diabetic testing supplies using a mail order option or a non-mail order option. 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. However, Medicare Part D-covered supplies such as syringes, needles and inhaled insulin devices are not included in the national mail-order program. 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").  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. 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. Beneficiaries who select the Mail-Order Option cannot have diabetic testing supplies shipped to a pharmacy and then have the pharmacy deliver Continue reading >>
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 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 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 >>