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Does Medicaid Cover Diabetic Supplies

Financial Help For Diabetes Care

Financial Help For Diabetes Care

How costly is diabetes management and treatment? Diabetes management and treatment is expensive. According to the American Diabetes Association (ADA), the average cost of health care for a person with diabetes is $13,741 a year—more than twice the cost of health care for a person without diabetes.1 Many people who have diabetes need help paying for their care. For those who qualify, a variety of government and nongovernment programs can help cover health care expenses. This publication is meant to help people with diabetes and their family members find and access such resources. 1American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36(4):1033–1046. What is health insurance? Health insurance helps pay for medical care, including the cost of diabetes care. Health insurance options include the following: private health insurance, which includes group and individual health insurance government health insurance, such as Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), TRICARE, and veterans’ health care programs Starting in 2014, the Affordable Care Act (ACA) prevents insurers from denying coverage or charging higher premiums to people with preexisting conditions, such as diabetes. The ACA also requires most people to have health insurance or pay a fee. Some people may be exempt from this fee. Read more about the ACA at HealthCare.gov or call 1–800–318–2596, TTY 1–855–889–4325. Key Terms Some terms listed here have many meanings; only those meanings that relate to the financial and medical aspects of diabetes and its management and treatment are included. affiliation period: a period of time that must pass before health insurance coverage provided by a health maintenance organization (HMO) be 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 >>

Diabetic Supplies

Diabetic Supplies

For more specific results, select both a chapter and section. To move from section to section within a chapter, use the left navigation bar. For best results, select a recommended search term if one appears in the search box. To narrow your search, use the Filter By and Additional Keywords features in the left navigation bar. To find an exact phrase, use quotes (e.g., prior approval). To find all search terms, use the word AND in capital letters between search terms. To find at least one search term, use the word OR in capital letters between search terms. Blood Glucose Meters and Testing Supplies HIP Commercial, EmblemHealth Medicaid, EmblemHealth Medicare HMO, EmblemHealth Medicare PPO and Medicare Prescription Drug Plan Members For the above plan members, EmblemHealth will cover blood glucose meters and testing supplies for Abbott Diabetes Care products only. For EmblemHealth Medicaid members, this coverage went into effect October 1, 2011. Patients who need a change in their testing frequency or the type of meter or supplies used will need a new prescription. Patients new to our plans may obtain a prescribed Abbott meter at no cost by calling1-888-522-5226 or by visiting theAbbott Diabetes Care website: www.AbbottDiabetesCare.com . Questions, product support or meter replacement? Please direct your EmblemHealth patients to call Abbott Diabetes Care Product Support at 1-888-522-5226 or go online at www.AbbottDiabetesCare.com . EmblemHealth EPO/PPO, GHI HMO, GHI PPO and GuildNet Plan Members Items not requiring prior approval, such as blood glucose meters and diabetic testing supplies (with the exception of insulin pumps and related supplies, which do require approval), may be directly requested from CCS Medical for the above-referenced plan members. EmblemHealth's f Continue reading >>

Mississippi Envision

Mississippi Envision

2. Does the pharmacy program ever reimburse for a non-covered drug for children? While there are many services not covered under the Division of Medicaid's state plan for pharmacy, there are circumstances that may allow coverage through EPSDT (refer to Policy Manual Section 73.09). Pharmacy providers are encouraged to contact the Bureau of Pharmacy at 601-359-5253. 3. Do children have monthly prescription limits? In cases of medically necessity, requests for more than the monthly benefit limits i.e. more than 5 prescriptions monthly or more than 2 brand name drugs for beneficiaries under the age of 21 are to be submitted via fax to Health Information Designs (HID) at 1-800-459-2135. There is no change in policy regarding drug benefits for children. Medically necessary prior authorization form for beneficiaries less than 21 may be found DOM's web site at www.medicaid.ms.gov , Pharmacy Services, and forms. Or call Health Information Designs at 1-800-355-0486. 4. Is DAW 7 still active for Narrow Therapeutic Index (NTI) drugs? Do NTI drugs count against the 2 brand limit? DAW 7 is still active for NTI Drugs. All legend brand name drugs, including NIT drugs, count against the 2 brand monthly limit. Some Narrow Therapeutic Index drugs have been added to the 90 Day Maintenance list. Please refer to DOM's web site at www.medicaid.ms.gov , Pharmacy Services, for most current 90 Day Maintenance List. 5. What pharmacy services are covered for beneficiaries who are in the Family Planning Waiver and have a `yellow Medicaid card? Beneficiaries enrolled in the Family Planning Waiver are eligible for Medicaid coverage of family planning services only and are not eligible for any other Medicaid services. The Family Planning Waiver program is a collaborative venture of the Mississippi D 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 >>

Diabetes Health Coverage: State Laws And Programs

Diabetes Health Coverage: State Laws And Programs

Diabetes Health Coverage State Laws and Programs Diabetes Health Coverage: State Laws and Programs This is a policymaker and consumer guide to state insurance mandated coverage, Medicaid coverage and state-sponsored diabetes programs. It was published 2011and updated material was added January 2016 All state law diabetes mandates and minimum coverage requirements for state-regulated health insurance policies. The tables include the enacted state laws passedsince the firstmandates inCalifornia (1981) and New York (1993). Use links below to go directly to state-based information: State Medicaid diabetes coverage terms and conditions. All Children's Health Insurance Program (CHIP) diabetes coverage. Contact information and an overview of federal funding provided by the Centers for Disease Control and Prevention (CDC) to state-sponsored diabetes prevention and control programs (DPCPs). DPCPs represent the front line in battling diabetes in most states. An overview of other state activities and initiatives, such as creation of diabetes coordinator positions in the executive branch to fight diabetes. Federal Health Reform.The federal Affordable Care Act (ACA) signed March 2010, has led to changed and expanded coverage termed "EssentialHealth Benefits." Newly Released: NCSL Survey:Diabetes Drug coverage: A new survey of2016 Insurance Plans in 50 states, examining 1) patient access to the scores of diabetes drug treatments and2) results in the 46 states with laws mandating or offering diabetes coverage. NCSL original research, published summer 2016. [Read the report] December 2015: " Diabetes: Addressing the Costs; A 50-State Budget Survey for FY 2014 ." NCSL released its latest diabetes report, taking a closer look at programs and budget appropriations that play a role in con Continue reading >>

Understanding Medicare Medicaid Diabetes Coverage

Understanding Medicare Medicaid Diabetes Coverage

Understanding Medicare Medicaid Diabetes Coverage (Source) Understanding Medicare Medicaid Diabetes Coverage – This primer on Medicare and Medicaid coverage for people with diabetes may help you understand the overall picture of the various parts of the public payor system in the USA. The reimbursement landscape in the US is very complicated. Each person’s circumstances must be considered individually for a complete perspective. Even so, let this brief summary serve to acquaint you with the major divisions in government run programs impact the person with diabetes. Part A, Part B, Part C, Part D … what do choose for your diabetes supplies? Medicare is USA’s basic health insurance program for people 65 years of age or older, or those people with disabilities who qualify. Medicare has four parts and you should understand the basic definitions as it applies to your benefits. Part A – This covers hospital insurance, helps to pay for inpatient hospital care, skilled nursing facilities, rehab centers, and additional follow up services. Part B – This helps pay for doctor visits, outpatient care, and additional other medical services such as DME supplies (Durable Medical Equipment). Part B covers theses services up to 80% of what Medicare reimburses for these services leaving the remaining 20% to the patient. The great news is most Part B recipients have secondary or supplemental coverage that cover the remaining 20%. In the case that the patient does not have additional coverage they can contact the Centers for Medicare and Medicaid at www.medicare.gov for financial help. Part C – This coverage is available in many parts of the country. This refers to Medicare Advantage Plans, such as HMOs and PPOs, and the coverage is dependent on the financial contribution of t Continue reading >>

Seven Little Known Secrets To Saving A Bundle On Diabetic Supplies

Seven Little Known Secrets To Saving A Bundle On Diabetic Supplies

Treating diabetes is costly. In fact, many people with the disease go without treatment with unfortunate results simply because they can't afford to pay for the treatments. It's wise to look for ways to reduce the costs of treating this disease because it's life-threatening. This article offers some ways to find affordable diabetic supplies. Some of the supplies you may need: Blood glucose meter Testing strips Lancets Log book Medications Insulin (in some cases) Syringes (for insulin) Insulin pen Insulin pump Seven Ways to Save on Diabetic Supplies Generics. Some medications are available now in generic forms. You doctor should be your guide for which ones are acceptable. However, you may be able to purchase generic medications and medical supplies for as little $3 or $4 a month. Some insurers provide them free of charge. Medicare. Medicare Part B pays 20% of Medicare-approved charges for a doctor's visit, but tests are covered. Medicare covers 20% of the Medicare-approved amount after the yearly Part B deductible for monitors, strips, lancets, and, in some cases, therapeutic diabetic shoes. They may also cover diabetic socks. Part D covers some of the supplies needed for administration of insulin. Part B covers an insulin pump at 20% of Medicare-approved amount. Medicaid. Medicaid usually covers diabetes supplies and medications. Check what your state will cover. You may need to make a co-payment. Samples. Manufacturers often offer free diabetic products. Ask your doctor. Also, if you attend conferences such as the American Diabetes Association Expo, samples are usually available for the taking. Compare Providers. If a blood glucose meter is given away free, be sure to compare the cost of strips and lancets. The meter may end up not being such a good bargain. Remember Continue reading >>

What You Should Know About Medicaid And Diabetes

What You Should Know About Medicaid And Diabetes

Medicaid is a government run health insurance program for poor and disabled people. According to the American Diabetes Association 3.5 million people with diabetes use Medicaid for all or some of their medical care. Ongoing and preventive health care is particularly important for people with diabetes to avoid costly medical complications. Many suggested changes to Medicaid may affect the level of care received by Medicaid recipients. Medicaid is often confused with Medicare. Medicare applies to all elderly, regardless of income and younger poorer individuals who have disabilities. Medicare for older individuals is not dependent on the individual being poor. Medicaid, however, has restrictions on the amount of assets an individual may have and/or the amount of income an individual can receive to be able to receive Medicaid assistance. Often the distinction is made that MedicAID means “assets and income depleted.” Medicare and Medicaid together cover over half the money that is spent on long term care in this country. The specific restrictions on Medicaid applicability is set by individual states. Some states limit income and some do not. The Federal Deficit Reduction Act (DRA) of 2005 made major changes to Medicaid eligibility requirements. In response to this Federal mandate, states have been tightening up their applicability requirements. For example, many states now look back for five years when determining if an individual has been giving assets away in a way that is prohibited by Medicaid eligibility rules. Any assets that have been given away contrary to Medicaid regulations may subject the donor to sanctions. The Affordable Care Act (ACA) of 2010, have also had effects on Medicaid. The ACA requires states to provide certain benefits to individuals. To be able Continue reading >>

Diabetes Programs And Supplies

Diabetes Programs And Supplies

For diabetic patients who need financial assistance with supplies and related health care items and services, the following programs may be of help. Please note that applications must be submitted to the programs and not to PPA® . Categories Insulin Access Programs Blink Health is working with Eli Lilly and Company to offer a 40 percent discount on Lilly insulins. The Blink Health Insulin Patient Access Program delivers the 40 percent discount directly to patients and will be honored at over 67,000 local pharmacies nationwide. Anyone can participate in the Blink Health Insulin Patient Access Program via the Blink Health mobile app (available for iOS & Android) or website, www.blinkhealth.com, which has no membership fees or monthly premiums. Patients enter the form, dosage and quantity of the Lilly insulin that matches their prescription. The discount will be automatically applied. Payments are made online and the prescriptions can be picked up at virtually any U.S. pharmacy, including: Walgreens, CVS/pharmacy, Target, RiteAid, Safeway and Kroger. People using federal government programs are not eligible. Purchases are fully refundable. Assistance: Insulin Free Glucose Meters Abbott Diabetes Care provides free blood glucose monitoring system kits to those with diabetes. Abbott Diabetes Care, Inc. 1360 South Loop Road Alameda, CA 94502 USA Tel: 888-522-5226 Fax: 202-337-8314 Email: [email protected] Assistance: Free Glucose Meters Test Strips Roche Diagnostics, the maker of ACCU-CHEK® Products provides a limited supply of ACCU-CHEK Aviva test strips to a network of community clinics and health centers throughout the U.S. to distribute to their low-income and uninsured patients with diabetes. Roache Diagnostics Corporation 9115 Hague Road Indianapolis, IN 46250 Phone: 800 Continue reading >>

Ga Medicaid Ffs & Orders - Prodigy Diabetes Care

Ga Medicaid Ffs & Orders - Prodigy Diabetes Care

GA Medicaid Fee-For-Service Members & Providers Effective October 1, 2011, the state of Georgia has selected Prodigy as a preferred brand of diabetes testing supplies for GA Medicaid FFS patients. Prodigy glucose meters and test strips are now available to all Georgia Medicaid beneficiaries with diabetes. Please contact your local pharmacy to receive your new Prodigy meter at no cost. Prodigy is one of the best blood glucose testing brands on the market and is located inCharlotte,NC.Prodigy AutoCode meter talks in English, Spanish, French and Arabic (option to turn talking feature off) and is fast and accurate.It is very easy to set up and use, and does not need to be coded its ready to go!Your doctor can help you with diabetes management and setting up your meter.You should be able to get a Prodigy meter from wherever you are currently receiving your diabetes supplies. Georgia Medicaid FFS beneficiaries will be able to use Prodigybrand monitors and test strips beginning October 1, 2011. Georgia Medicaid FFS beneficiaries who are also covered under Medicare or another third party insurance provider do not have to change, although Prodigyis available to them as well. Diabetes patients under Georgia Medicaid FFS will have Prodigy meters available to them at no charge. You should be able to continue to get your supplies from your local clinic or pharmacy. Medicaid covers the entire cost of diabetes supplies for its beneficiaries (with the exception of the preferred brand co-payment). Prodigy meters will be billed to and reimbursed by Prodigy. For more information, please contactthe Division of Medical Assistance Pharmacy Services Unit at 404-656-4044. All questions about the meter or products should go to the ProdigyCustomer Care and Technical Support Hotline at 1.866.540 Continue reading >>

Nc Medicaid Expects To Save Millions With New Diabetic Supplies Vendor

Nc Medicaid Expects To Save Millions With New Diabetic Supplies Vendor

NC Medicaid announced Tuesday that it expects to save $6 million annually through a sole-source for diabetic supplies. Roche Diagnostic Corp, maker of the Accu-Chek line of blood glucose meters and test strips, beat eight competitors for the contract, which took effect November 15, 2011, and will run for one year, with options for another two years. The Division of Medical Assistance (DMA), North Carolinas Medicaid agency, entered a similar arrangement two years ago with Prodigy Diabetes Care. That contract expired November 14, 2011. DMA is working with both Roche and Prodigy on a transition plan that will extend into January 2012. During the transition period, Roche will provide a glucose meter to the nearly 77,000 NC Medicaid and NC Health Choice members living with diabetes. As under the previous contract, other brands will be available on a prior-approval basis for specific medical circumstances. The meters are free. DMA will pay for disposable test strips, control solution, lancets and lancing devices. Insulin syringes, which Prodigy supplied under the expiring contract, are no longer a sole-source item. Continue reading >>

Insurance Resources For Persons With Diabetes

Insurance Resources For Persons With Diabetes

Lack of health insurance is a major obstacle to managing diabetes. Below are links regarding options for obtaining health insurance in Texas, and frequently asked questions about diabetes equipment, supplies, medication and training that may or may not be covered by certain types of health plans. The Texas Diabetes Council does not provide or guarantee insurance coverage. It is the responsibility of the individual seeking health insurance to provide information related to eligibility and other application information to the appropriate insurance provider when seeking coverage. External links to other sites are intended to be informational and do not have the endorsement of the Texas Department of State Health Services. These sites may not be accessible to persons with disabilities. Texas Health Options Consumer information from the Texas Department of Insurance about finding group coverage, determining whether you qualify for Medicaid or Medicare, applying for coverage through the Texas Health Insurance Pool, or buying an individual policy. Includes information about plans available through the federal health insurance marketplace (www.HealthCare.gov). Texas Medicaid Site provides a list of Medicaid services in Texas, including eligibility criteria. Medicaid is the State and Federal cooperative venture that provides medical coverage to eligible needy persons. Texas Children’s Health Insurance Program (CHIP): The Children’s Health Insurance Program (CHIP) is a national program designed for families who earn too much money to qualify for Medicaid, yet cannot afford commercial insurance. Coverage is available for qualified children from birth through age 19). Medicare Formerly the Health Care Financing Administration (HCFA), now the Centers for Medicare & Medicaid Serv Continue reading >>

Indiana State Department Of Health

Indiana State Department Of Health

Indiana Insurance Indiana Legislation of Diabetes Insurance Coverage Medically necessary treatment for diabetes, including medically necessary supplies and equipment. For example, blood glucose monitors, blood glucose test strips, insulin, syringes, insulin pumps and accessories and oral diabetes medications. Diabetes self-management training, which includes: One or more visit(s) after receiving an initial diagnosis of diabetes. One or more visit(s) if it is determined by a physician or podiatrist that there has been a change in your condition or that a change in treatment is medically necessary. For example, you have been able to manage your diabetes with meal planning and now must begin oral medication or insulin. One or more visit(s) for re-education or refresher training ordered by a physician or podiatrist. Anyone with diabetes (insulin or non-insulin using) and elevated blood sugar as a result of pregnancy or other medical conditions. Must be covered by insurance, Medicaid or the state health plan to qualify. If unsure of coverage, contact your employer's human resource department to verify coverage. When does coverage take effect? Coverage for IC 27-8-14.5 takes effect when your insurance policy is renewed. 1998 Legislation. Do I need a prescription? Written order from a physician or podiatrist for medically necessary supplies, equipment and/or self-management training. Self-management training must be provided by a licensed health care professional who has special training in diabetes management. What to do if my claim is denied? Verify you have appropriate documentation to get reimbursed (i.e., physician order). Ensure your health plan is not self-funded (which would not be covered under this bill). Resubmit your claim with a letter of explanation regarding you Continue reading >>

New: 2017 Diabetic Meter Program

New: 2017 Diabetic Meter Program

News Effective January 30, 2017, Superior HealthPlan will launch a Preferred Diabetic Meter Program. Superior’s preferred brand of blood glucose meter and test strips will be from TRUE METRIX. These supplies will be available to members at no cost. A letter has been sent to members notifying them of this new program, with information on how to receive new blood glucose supplies. Frequently Asked Questions: When does this program go into effect? Effective January 30, 2017, the program will be available to members with no prescription claim history for a meter or supplies. For members with a history of prescription claims for other meters, the program will take effect on March 1, 2017. How do members get a new, preferred blood glucose meter? In order for members to receive the preferred blood glucose meter at no cost, providers will need to write a prescription for a TRUE METRIX Air or TRUE METRIX Meter. Prescribers will also need to ensure the member takes the prescription and the processing information (in the table below) to a drug store or pharmacy in Superior’s network. List of Preferred Diabetic Meters Claims Processing Information TRUE METRIX AIR TRUE METRIX Meter Rx BIN Number: 015251 PCN Number: PRX2000 Identification Number: HB224289445 Group Number: TRUEPORT22 What happens when a member fills their prescription? When members attempt to fill their prescription for a meter, a point-of-sale message will direct the pharmacist to dispense a TRUE METRIX Air or TRUE METRIX Meter and corresponding test strips (if applicable) to the member at no charge. What if the pharmacy does not have the meter in stock? If the pharmacy does not have the preferred meter in stock, they can either order the meter or redirect the member to another in-network pharmacy. The member can Continue reading >>

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