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Are Diabetic Test Strips Covered By Medicare?

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 >>

Blood Glucose Test Strip Utilization Within Medicare

Blood Glucose Test Strip Utilization Within Medicare

Blood Glucose Test Strip Utilization Within Medicare 1Jennifer Hahamian Consulting LLC, Los Gatos, California Jennifer Hahamian, BSC, MBA, Jennifer Hahamian Consulting LLC, 125 Loma Alta Ave, Los Gatos, CA 95030, USA. Email: [email protected] Keywords: competitive bidding, diabetes supplies, DME, glucose test strips, Medicare Copyright 2014 Diabetes Technology Society An editorial in this journal previously reported sales of blood glucose meters and test strips composed at least two-thirds of the diabetes technology market, and consequently expressed concern over the potential impact of the Medicare Competitive Bid program. 1 Considering the relatively high use of strips by US Medicare beneficiaries, and given multiple Medicare reimbursement changes were implemented in 2013, presented here are 5 years of Medicare test strip utilization. No hypothesis is provided; however, this information may assist with future forecasting. In 2009, Fee-for-Service Medicare beneficiaries received in excess of 2 billion blood glucose test strips ( Table 1 ). In the same year, the Advanced Medical Technology Association (AdvaMed) reported approximately 6.2 billon diabetes patient self-tests were performed, 2 suggesting that Medicare beneficiaries accounted for roughly a 30% share of the test strip market volume. In addition, 62% of test strips were provided to beneficiaries via mail from durable medical equipment (DME) distributors, while 38% of strips were obtained from retail locations. 3 Medicare Allowed Blood Glucose Test Strip Claims 2008-2012. Allowed number of test strip units (1 unit = 50 strips) 6 Number of beneficiaries for allowed claims 6 Allowed charges (amount paid to distributor including 20% patient copay) ($) 6 In the 2008 to 2013 timeframe, the Centers for Medicare Continue reading >>

2 Ways You Could Save On Blood Sugar Test Strips

2 Ways You Could Save On Blood Sugar Test Strips

Blood sugar testing is a way to keep track of how well diabetes is being managed. Test results help to show how food, physical activity and diabetes medications affect blood sugar. The number of blood sugar tests a person with diabetes may do varies. It depends on the treatment plan. Some people test their blood sugar several times a day. Others test less often. Sometimes extra tests may be needed, such as when starting a new medication or adjusting an insulin dose. Every blood sugar test uses a test strip. Every box of strips usually comes with a cost–typically a 20% co-insurance payment after the Part B deductible. It could be tempting to skip tests if strips start to cost too much. Medicare understands how important regular testing is to diabetes self-management. There is now a competitive bidding process that helps Medicare select suppliers that meet its standards for the quality and cost of diabetic supplies. Here are two ways that you can get the blood sugar test strips you need at the lower cost that Medicare’s competitive bidding process offers. 1. Order blood sugar test strips from a Medicare contracted mail-order supplier. Medicare has a mail-order program for diabetic testing supplies. Medicare sets the amount it will pay based on bids from suppliers. Contracted suppliers may not charge you more than 20% co-insurance on the Medicare-approved amount. You can enter your zip code to find a supplier on the Medicare web site. Check the box for “Mail-Order Diabetic Supplies,” then scroll down and click the Search button. You’ll get a list of contracted suppliers. You’ll need to check each supplier to see which ones carry what you need. You can usually transfer your prescription to any supplier. Test strips or other diabetic supplies you order can then b Continue reading >>

Medicare Cost-cutting On Diabetes Test Strips Puts Lives At Risk, Study Finds

Medicare Cost-cutting On Diabetes Test Strips Puts Lives At Risk, Study Finds

The research puts data behind long-simmering complaints from patients and clinicians about availability of diabetes test strips. A competitive bidding program designed to save Medicare money has instead put beneficiaries with diabetes in the hospital, driving up costs for both patients and taxpayers and causing the untimely death of some, according to a study published today in the journal Diabetes Care.1 Study authors called on CMS to halt bidding for diabetes test strips until the program’s flaws can be fixed, with one author saying that the rock bottom prices and lack of standards have left beneficiaries low-quality strips from “off shore” suppliers, which can give inaccurate results. Research by the National Minority Quality Forum puts data behind long-simmering complaints about the availability of diabetes test strips for Medicare patients, which have increased since CMS switched to a competitive bidding program for these critical supplies. Those who use insulin to regulate their diabetes use test strips monitor blood glucose levels several times a day, which help them decide how much insulin they need, to manage their diet, and to avoid episodes of hypoglycemia. CMS started the pilot in 9 test markets in 2011; after CMS declared it a success it was expanded nationwide in 2013. But the study published today reaches a shocking conclusion: armed with the same data available to CMS, the team found that the low reimbursement levels during the pilot program—which fell from $34 to $14 per vial—led to disruptions in supplies, causing some patients to monitor their blood sugar less frequently or not at all. “Based on our findings and employing the safety monitoring protocols commonly used to protect human subjects, we believe policymakers should immediately sus Continue reading >>

What Diabetic Supplies Are Covered By Original Medicare?

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 >>

Medicare Coverage For Contour Next And Breeze Meters | Contour Next

Medicare Coverage For Contour Next And Breeze Meters | Contour Next

Important note: A doctor's prescription is required for Medicare reimbursement. If your doctor recommends that you test more often than Medicare's guidelines permit, your doctor can authorize you to receive more self-testing supplies which Medicare will cover after additional requirements are met. For more information, check with your doctor and/or medicare.gov . What is Medicare's Competitive Bidding Program? Congress passed a law requiring Medicare to implement a Competitive Bidding Program for certain durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). The program changes the amount Medicare pays suppliers for DMEPOS supplies and changes who can provide these items to Medicare beneficiaries. Under this program, suppliers submit bids to furnish certain DMEPOS products to Medicare beneficiaries. Based upon the bids, Medicare determines the amount it will pay for the supplies and selects the suppliers who can provide the products. Has the Competitive Bidding Program started? The competitive bidding program started on July 1, 2013. Reimbursement amounts for suppliers changed at this time to the amounts achieved through the bidding program. If you currently receive your CONTOURNEXT, CONTOUR or BREEZE2 from a mail order supplier, and your current mail order supplier was not selected as a "winner" by Medicare, you may need to find a new Medicare "contracted" mail order supplier or you may purchase your CONTOURNEXT, CONTOUR or BREEZE2 at a local pharmacy. Are diabetes testing self-supplies included in the program? Yes, but only for diabetes self-monitoring testing supplies delivered through the mail. This program does not affect diabetes testing supplies purchased at retail pharmacies. Are CONTOURNEXT,CONTOUR or BREEZE2 diabetes self-monitoring testing Continue reading >>

Professional + Long Term Care

Professional + Long Term Care

Many health insurance plans and Medicare cover much of the cost of diabetes testing supplies, including blood glucose monitors and test strips. Private Insurance Coverage The cost of diabetes testing supplies are covered by many private insurance and managed healthcare plans. It's possible that a portion or all of your diabetes treatment and supplies will be covered under your plan. To determine your coverage, talk to your insurance provider. What is Medicare? Medicare is a federal health insurance program for United States Citizens over 65 years of age, permanently disabled people under the age of 65, and people with end-stage renal disease (ESRD). Medicare Part A and B Medicare Part A - Hospital Insurance (HI) that pays for inpatient hospital care and skilled nursing facility care. Hospice care and some home healthcare is also covered. Medicare Part B - Supplemental Medical Insurance (SMI) that pays for physician and non-physician services, outpatient hospital services, durable medical equipment, diagnostic tests, and various other medical services and supplies not covered under Part A. Coverage and reimbursement for Home Blood Glucose Meters and their associated supplies falls under Medicare Part B. All Medicare beneficiaries who are at risk for complications from diabetes may also be eligible for diabetes self-management training. What products does Medicare cover? If you're receiving Medicare Part B benefits, you can be reimbursed for most of your costs. This applies to you whether you use insulin or not. These diabetes care products from ARKRAY are covered under the Medicare Benefits: GLUCOCARD® Expression™ Audio-enabled Blood Glucose Monitoring System GLUCOCARD® Expression™ Blood Glucose Test Strips GLUCOCARD® 01 Blood Glucose Monitoring System GLUCOCARD® Continue reading >>

Covering The Bases: Different Medicare Plans Cover Certain Diabetes Supplies

Covering The Bases: Different Medicare Plans Cover Certain Diabetes Supplies

I am diabetic. I have Original Medicare, a Medigap and a Part D drug plan. I am confused as to what covers my insulin and syringes and what covers my test strips/lancets to test my blood sugar. This question is very common. Medicare Part B (your red, white and blue card) covers your test strips and lancets that you use to test your blood sugar. Medicare Part B will pay 80 percent of the Medicare-approved amount for these items. Your Medigap plan would cover the remaining 20 percent. Your insulin and the syringes you use to inject your insulin are covered under your Medicare Part D drug plan. You may want call 1-800-MEDICARE or visit www.medicare.gov to obtain a copy of a booklet entitled "Medicare Coverage of Diabetes Supplies and Services." This booklet provides more details about Medicare benefits for people with diabetes. I enrolled in a Medicare Part D plan in December, and I saved my confirmation number. Here it is the end of January and I never received a card in the mail. I need my medicines and, without my card, I must pay full price. What can be done? Call the drug plan's customer service number and request they re-send a card and double check the address your plan has on file. Also ask your drug plan for your ID number, your PCN number, your BIN number and your group number. These are the numbers that will be printed on your plastic drug card. You may provide these numbers to your pharmacist in lieu of a plastic card. Your pharmacist may then process your claims through your drug plan, saving you from having to pay full price for your medicines. If you are not sure of your plan's phone number, or you need further help, you may contact 1-800-MEDICARE or your local Senior Health Insurance Assistance Program office at 410-222-4257. I am turning 65 and will have M 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 >>

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 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 >>

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 >>

Coverage Of Diabetic Testing Supplies For Dual Eligibles

Coverage Of Diabetic Testing Supplies For Dual Eligibles

Coverage of Diabetic Testing Supplies for Dual Eligibles We frequently hear from dual eligibles (people who have Medicare and Medicaid) who have problems getting their diabetic testing supplies at their local pharmacy or who end up being charged more than they should for these items. As a result, we want to review how coverage for these items works when someone has both insurances and gets their diabetic testing supplies at a local pharmacy. Diabetic testing supplies include test strips and lancets which are used to test the blood sugar level in people who have Diabetes. Unlike insulin and needles that are covered solely by Medicare Part D, testing supplies are covered by Medicare Part B. When people get these items at a local pharmacy, the pharmacist should bill their Medicare coverage first (either Original Medicare or their Medicare Advantage plan). Then, the pharmacist should bill the ACCESS card second. After billing both insurances, a dual eligible should only be charged a very small Medicaid co-pay (no more than $3 for each item). In some cases, there may not be any co-pay. Pharmacists who are having problems getting Medicaid (ACCESS) to pay second for test strips and lancets should call the Medicaid Pharmacy Services Provider Call Center at 1-800-537-8862, select Option 1 and then Option 1 again. Dual eligibles who experience problems getting their diabetic testing supplies at the pharmacy can call Pennsylvania Health Law Projects Helpline at 1-800-274-3258 for assistance. 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 >>

Everything You Need To Know About Prediabetes And Diabetes Supply

Everything You Need To Know About Prediabetes And Diabetes Supply

Diabetes is a serious lifelong condition that may cause other major health problems if you do not keep your blood glucose under control. Whether you are a prediabetes candidate or already have diabetes, it is crucial to understand fully what supplies you need in order to monitor and control your blood glucose level, and alleviate various conditions that may exhibit along with the condition. Prediabetes Supply – Things Prediabetics Need Getting diagnosed with prediabetes is a serious wake-up call to your current health, but it doesn’t have to mean you will most definitely get diabetes. With close monitor to your blood glucose level and paying attention to lifestyle changes, you can slow down the progression to diabetes or even prevent diabetes. Physical activity is an essential part of the treatment plan for prediabetes because it lowers blood glucose levels and decreases body fat. Depending on your health insurance company policy, you may be qualified for an incentive for joining a gym or fitness program. If your insurance company does not offer an incentive, you can try asking about your working company policy and see if they have an incentive for their workers getting fit. At the same time, they may offer an incentive for going to a nutritionist and plan out a diet plan for your needs. However, if both your insurance company and your working company both do not offer incentives, you can still claim these expenses as medical expenses on your tax as long as you have documentation of these treatments being recommended by your doctor. Sleep is crucial for prediabetes candidates. Without proper amount of sleep, your body cannot use insulin effectively and may increase your chance of developing type 2 diabetes. If you suffer from sleep apnea, do seek help from your doct Continue reading >>

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