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 >>
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 >>
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Does Medicare Cover Diabetic Supplies?
I want to compare Medicare Supplement Plans. Or chat about my options with an agent: 1-888-264-0148 Certain diabetic supplies such as self-testing equipment and lancets are covered by Medicare, though there are some limits to that coverage. If you are living with diabetes, talk to your doctor or health care provider to find out what testing and supplies are right for you and how often youll need them. Medicare Part B Covers SomeDiabetes Supplies The diabetes equipment and supplies that are covered by Medicare Part B (medical insurance) include the following: Insulin pumps (and insulin that the device uses) Medicare Part B also provides coverage for some services for people with diabetes: Medicare Part B will not cover insulin unless it isused in an insulin pump. Medicare Part B also does not cover certain medical supplies used to administer insulin such as syringes, needles, insulin pens, alcohol swabs or inhaled insulin devices. Medicare does not cover anti-diabetic drugs used to maintain blood sugar. A Medicare Part D Prescription Drug Plan may provide coverage for insulin and other medications. Rules For Getting Your Diabetes Supplies Under Medicare For most diabetic self-testing equipment and supplies, you need to get a prescription from your doctor in order for Medicare to cover it. The prescription should specify: What kind of durable medical equipment (DME) you need and why you need it How often you should test your blood sugar How many test strips and lancets you need (per month) You can either order and pick up your supplies at a pharmacy thats enrolled in Medicare, or have them delivered to your home using a national mail-order contract supplier . You must get your diabetic supplies from a participating pharmacy or supplier thats enrolled in Medicare. Otherwi 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 >>
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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 >>
Cvs/pharmacy Reminds Patients With Diabetes About The Importance Of Regular Testing To Help Manage Their Disease
WOONSOCKET, R.I., May 20, 2013 /PRNewswire/ --CVS/pharmacy is reminding patients with diabetes that one of the most important ways they can manage their disease is to perform regular testing of their blood sugar (glucose) levels. While the number of providers that will accept Medicare coverage for diabetes testing supplies is expected to decline after July 1, 2013 due to Medicare changes, CVS/pharmacy is informing those treating diabetes it will continue to accept Medicare Part B coverage for test strips and other diabetes testing supplies. The Company has more than 7,400 locations in the U.S. and stocks all major brands of diabetes supplies. "More than 25 million people in the United States have diabetes and every 17 seconds, another American is diagnosed with diabetes, so it is critical that patients continue to have affordable access to diabetes testing supplies to help them manage their disease," said Papatya Tankut, RPh, Vice President of Pharmacy Affairs at CVS Caremark. "CVS/pharmacy is committed to ensuring that Medicare patients can use their insurance coverage for test strips and other diabetes supplies. We also offer 90-day supplies of prescription test strips at the same low price as mail order." CVS pharmacists are available every day as a resource for patients with diabetes who need advice or who have questions about prescription and over the counter medications to manage their disease. CVS/pharmacy can also assist patients with any new paperwork from their doctor's office that is required by the changes Medicare is making to coverage of diabetes testing supplies. Another resource CVS/pharmacy offers patients with diabetes is the ExtraCare Advantage for Diabetes program, which has helped more than 2 million members save money and better manage the disease 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 >>
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 >>
Blood Sugar (glucose) Test Strips
How often is it covered? Medicare Part B (Medical Insurance) covers some diabetic test supplies, including blood sugar test strips as durable medical equipment (DME). Who's eligible? All people with Part B who have diabetes are covered. Your costs in Original Medicare If your supplier accepts assignment, you pay 20% of the Medicare-approved amount, and the Part B deductible applies. Medicare pays for different kinds of DME in different ways. Depending on the type of equipment: You may need to rent the equipment. You may need to buy the equipment. You may be able to choose whether to rent or buy the equipment. Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them. It’s also important to ask your suppliers if they participate in Medicare before you get DME. If suppliers are participating suppliers, they must accept assignment. If suppliers are enrolled in Medicare but aren’t “participating,” they may choose not to accept assignment. If suppliers don't accept assignment, there’s no limit on the amount they can charge you. Competitive Bidding Program If you live in or visit certain areas, you may be affected by Medicare's Competitive Bidding Program. In most cases, Medicare will only help pay for these equipment and supplies if they're provided by contract suppliers when both of these apply: Contract suppliers can't charge you more than the 20% coinsurance and any unmet yearly deductible for any equipment or supplies included in the Competitive Bidding Program. You may need to use specific suppliers for some types of diabetes testing sup Continue reading >>
When Do You Need A Prescription For Diabetic Test Strips?
When Do You Need A Prescription for Diabetic Test Strips? Whether or not you need a prescription to purchase diabetic test strips depends on one thing. Read this article to find out how it all works. If you’re one of the 29 million Americans living with diabetes, you likely have a lot of questions about how to get the medication you need. We’re sure you also have questions about how you can keep the costs of supplies, test strips, lancets, and hospital visits down. Even if you’re working out and taking care of yourself, you may feel like you can’t do much to fight back against the rising costs of life with diabetes. In this post, we’ll talk about whether or not you need a prescription to get diabetic test strips. We’ll also talk about how the cost of diabetes is different for the insured and the uninsured diabetes patient. No matter what your coverage is like, it’s always a smart idea to look for bargains, ways to save, and ways to make back some of the money you’ve spent on diabetic test strips. Read this post to learn how to save better. The Costs Of Diabetes: Insured vs. Uninsured There’s no getting around it: life with diabetes is costly. In fact, recent figures show that the average yearly cost for one person living with diabetes is about $13,700. Unfortunately, that same study showed that those without health insurance who are living with a diabetes diagnosis get 68% fewer prescriptions, and 79% fewer doctor visits, than those that are insured. Though most states have made sure insurance companies are required to cover medical costs and supplies, you still have to do a good amount of work to get certain things covered by your plan. You may even have to write them letters just to make back a small portion of what you spend on supplies like diabeti 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 >>
Does Medicare Cover Diabetes-related Medical Expenses?
Medicare covers 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. Medicare also covers the cost of therapeutic shoes, self-management training, nutrition counseling, flu and pneumococcal pneumonia shots, and glaucoma screening for people with diabetes. For more information, see Medicare Coverage of Diabetes Related Supplies and Services at the Medicare Web site. In addition, Medicare beneficiaries aged 65 years and older who have diabetes and haven’t had a medical eye exam in the past three years can receive a free comprehensive eye exam and up to one year of follow-up care for any condition diagnosed at the initial exam. Does Medicaid cover diabetes-related medical expenses? Medicaid is a state administered program and each state sets its own guidelines regarding eligibility and services. Visit the Medicaid Site for Consumer Information to locate information by state. How do I figure the cost of diabetes for my company? Where can I find free or low-cost diabetes coverage and services? The Bureau of Primary Health Care within the Health Resources and Services Administration (HRSA) has a nationwide network of community-based health care centers that provide primary health care services at little or no cost. Hospitals and other health care facilities participating in HRSA’s Hill-Burton Program provide free and low-cost services to eligible individuals. The State Children’s Health Insurance Program (SCHIP) provides free or low-cost health insurance for children. The Partnership for Prescription Assistance provides information about public and private patient assi Continue reading >>
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 >>
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 >>
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 >>