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Does Medicare Cover Insulin Pump For Type 2 Diabetes

Aade: Medicare Isn't Providing Diabetes Supplies Like It Should

Aade: Medicare Isn't Providing Diabetes Supplies Like It Should

Seems like there's always some new roadblock cropping up to thwart us from getting the diabetes supplies we need… The latest hurdle comes from the beleaguered Centers for Medicare & Medicaid Services (CMS). According to a new survey just released by the American Association of Diabetes Educators (AADE) on Feb. 3 -- surprise, surprise! -- CMS is now limiting patient access to insulin pumps as well as meters, strips and other basic supplies. The results are disturbing, and they add to the already dismal state of affairs at as it pertains to diabetes. Remember that CMS introduced its controversial competitive-bidding process in 2013, requiring PWDs (people with diabetes) on Medicare to choose from an approved short-list of diabetes suppliers to get what they need to survive. First, this limited only glucose meters and strips by mail-order. And then the limits expanded to pharmacies. We were worried, but were reassured by the government and CMS leaders that all would be OK. Yet an initial AADE survey from early 2014 found that the competitive-bidding process was failing PWDs on Medicare who needed mail-order testing supplies. Because CMS is not properly monitoring the companies selected for the bidding process and “the agency has not taken action against suppliers who have changed their offerings since their bids were accepted,” they are getting away with offering customers the cheapest, lowest-quality glucose meters, according to testimony from AADE Chief Advocacy Officer Martha Rinker in the 2014 survey. CMS recently announced inclusion of insulin pumps on the list of medical supplies going through competitive-bidding in nine regions across the country. For the AADE survey conducted last Fall, educators across the country called up a total of 29 different supplies l 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 >>

Medicare And Diabetes Technology Insurance Coverage

Medicare And Diabetes Technology Insurance Coverage

I’m still a number of years away from retirement and reaching Medicare age, but I have to admit that the current Medicare coverage (or lack thereof) for diabetes technology causes me to feel more than a little concern. It’s awesome that people with diabetes are living normal lifespans, but the current Medicare system is not set up to provide coverage of the technologies that we become accustomed to using when we have commercial insurance coverage to control the disease as well as we can. When you are young and have commercial health insurance, you use tools like brand name, accurate glucose meters, Continuous Glucose Monitors (CGMs), and insulin pumps. Depending upon your insurance, you may have some restrictions on certain products, or pay more than you would like in co-pays. But the technology or products you want are often not out of reach. Many of the glucose meters on the market have programs which lower your co-pay for test strips. You pay a co-pay and get your insulin. You might prefer to use Novolog but your insurance pays for Humalog, but at least you can get your products. You can probably get an insulin pump if you have Type 2 diabetes if you want one and your physician prescribes it. And you can get a new insulin pump every four years when the old one goes out of warranty. There can be a lot of variation in what is covered, and how much you pay out of pocket, depending upon your insurance coverage. I realize that some people on commercial insurance have it a lot better than others. Did you know that Medicare doesn’t cover insulin pumps the same way that commercial insurance does? They require a test to prove that you don’t make your own insulin and need an insulin pump, as opposed to just wanting one to improve your diabetes management. Type 1s can q Continue reading >>

Medicare Coverage Of Insulin Pumps

Medicare Coverage Of Insulin Pumps

This information is from the Medicare Coverage Issues Manual for Durable Medical Equipment Original Document -- cms.hhs.gov/transmittals/downloads/R143CIM.pdf Program Memorandum -- Carriers billing codes HEADER SECTION NUMBERS PAGES TO INSERT PAGES TO DELETE 60-14 - 60-14 (Cont.) 2 pp. 2 pp. NEW/REVISED MATERIAL--EFFECTIVE DATE: January 1, 2002 Section 60-14, Infusion Pumps, revises the C-peptide requirement to be less than or equal to 110 percent of the lower limit of normal of the laboratory's measurement method. This change expands the value of the laboratory test to be considered in determining coverage of the insulin infusion pump for all diabetic patients. (Type II diabetics are no longer excluded.) This section of the Coverage Issues Manual is a national coverage decision made under §1862(a)(1) of the Social Security Act (the Act). National coverage determinations (NCDs) are binding on all Medicare carriers, intermediaries, Peer Review Organizations, and other contractors. Under 42 CFR 422.256(b) an NCD that expands coverage is also binding on a Medicare+Choice Organization. In addition, an administrative law judge may not disregard, set aside, or otherwise review a national coverage decision issued under §1862(a)(1) of the Act. (42 CFR 405.732, 405.860.) DISCLAIMER: The revision date and transmittal number only apply to the redlined material. All other material was previously published in the manual and is only being reprinted. 60-14 INFUSION PUMPS THE FOLLOWING INDICATIONS FOR TREATMENT USING INFUSION PUMPS ARE COVERED UNDER MEDICARE: A. External Infusion Pumps.-- sections 1 - 4 deleted, not about insulin infusion pumps 5. Continuous subcutaneous insulin infusion pumps (CSII) (Effective for Services Performed On or After 4/1/2000).-- An external infusion pump Continue reading >>

Making The Switch To Medicare With Diabetes

Making The Switch To Medicare With Diabetes

By Pearl Subramanian and Jeemin Kwon From enrolling in the four types of plans to what they cover, everything you need to know when making the switch to Medicare with diabetes Despite covering 58 million Americans in 2017, Medicare can be difficult to navigate. The US-government-run program provides health coverage to people over the age of 65 and to those under 65 who have certain disabilities or other conditions. If you are ready to make the switch over to Medicare or know someone who is, this article is a guide on what you need to know for as smooth a transition as possible, understanding that there are plenty of complexities here! Click to jump to a section: About Medicare Though Medicare is often thought of as one big plan, it actually has four different types of coverage: Part A covers hospital stays, care in nursing facilities, hospice care, and home health care. Part B covers doctors’ services, non-hospital (outpatient) care, some medical devices and preventative services. People pay a monthly premium for this coverage. Part C allows people the option to enroll in private insurance plans (HMOs and PPOs) and to receive their benefits under Parts A and B. Those plans are called Medicare Advantage and some offer additional benefits such as dental and vision. Part D covers prescription drugs and is voluntary. For more information on decoding and understanding health insurance language, check out diaTribe’s guide here. Medicare and Diabetes Medicare covers certain benefits and supplies specific to people with diabetes, including diabetes drugs, blood glucose monitoring equipment, insulin delivery devices, and therapeutic shoes/inserts. Refer to Medicare and Diabetes Coverage for additional information regarding these provisions, and see the table below to learn w Continue reading >>

New Results On Insulin Pumps And Type 2 Diabetes | The Loop Blog

New Results On Insulin Pumps And Type 2 Diabetes | The Loop Blog

Home Innovation Clinical Trial Update: New Results On Insulin Pumps And Type 2 Diabetes Clinical Trial Update: New Results On Insulin Pumps And Type 2 Diabetes Posted by Dr. Francine Kaufman On April 13, 2016 In Innovation At Medtronic, a significant investment in clinical research is a key part of how we help people with diabetes enjoy greater freedom and better health. Its what allows us to evaluate the effectiveness of new technologies or existing technologies for new groups of people. And, in addition to helping health care providers decide what therapies to prescribe to best help their patients, it plays a big role in reimbursement. Were excited to announce the results from the continuation phase of the OpT2mise trial. This is the largest global study to evaluate and compare insulin pump therapy versus multiple daily insulin injections for people with type 2 diabetes. These results could improve access to insulin pumps for the 20 million people around the world with type 2 diabetes who require insulin. Many health systems and governments around the world have said there is not enough scientific evidence to support use of insulin pump therapy in type 2 diabetes (even if they cover insulin pumps for people with type 1 diabetes). With the robust scientific data from this important study, Medtronic will partner with healthcare systems to demonstrate how effective this therapy can be to improve clinical outcomes. Initial results of OpT2mise showed that after six months, people with type 2 who used MiniMed insulin pumps achieved better glucose control than those using multiple daily injections (MDI). This is confirmed now that we have data from the one year continuation phase of the study. One of the biggest myths about insulin pump therapy is that its only for people w Continue reading >>

Medicare Will Pay For Insulin Pumps

Medicare Will Pay For Insulin Pumps

A.������� The patient has completed a comprehensive diabetes education program, and has been on a program of multiple daily injections of insulin (i.e. at least 3 injections per day) with frequent self-adjustments of insulin dose for at least 6 months prior to initiation of the insulin pump, and has documented frequency of glucose self-testing an average of at least 4 times per day during the 2 months prior to initiation of the insulin pump, and meets one or more of the following criteria while on the multiple daily injection regimen: ����������� 1.�������� Glycosylated hemoglobin level (HbA1c) greater than 7.0% ����������� 2.�������� History of recurring hypoglycemia ����������� 3.�������� Wide fluctuations in blood glucose before mealtime ����������� 4.�������� Dawn phenomenon with fasting blood sugars frequently exceeding 200mg/dL ����������� 5.�������� History of severe glycemic excursions B.�������� The patient with type 1 diabetes has been on a pump prior to enrollment in Medicare, and has documented frequency of glucose self-testing an average of at least 4 times per day during the month prior to Medicare enrollment. Other Requirements: ����������� Type 1 diabetes needs to be documented by a C-peptide level less than 0.5. ����������� The pump must be ordered by, and follow-up care of the patient must be managed by a physician who manages multiple patients with CSII (pump therapy), who works closely with a team including nurses, diabetes educators, and dietitians who are knowledgeable in the use of CSII. Continue reading >>

Medicare And Diabetes: What Is Covered?

Medicare And Diabetes: What Is Covered?

Medicare is the federal health insurance program for people age 65 and older as well as people under age 65 with disabilities and those living with End-Stage Renal Disease. Original Medicare, the most common way to receive Medicare is comprised of part A and part B. Part A is hospital insurance and will cover most medically necessary hospital, home health, skilled nursing facility, and, hospice care. Part B is medical insurance paid for by a monthly premium and covers most medically necessary doctors’ services, durable medical equipment, preventive care, hospital outpatient services, lab tests, x-rays, mental health care, and some home health and ambulance services. You can choose to also get Medicare Part D which is prescription drug insurance and is provided only through a private insurance company that has a government contract. There is also the alternative option to get a private Medicare plan called a Medicare Advantage Plan or Medicare Part C, which generally includes Part D coverage. The Medicare Plan A deductible for 2017 is $1,316 and depending on how long your stay is, you may have to pay an additional amount. The Plan B monthly premium for most Americans in 2017 is $109, though people pay more depending on income level. You can find out your monthly premium by calling Social Security at 1-800-772-1213. You may also have to pay a deductible for Part B. In 2017 the Part B deductible is $183 and after you pay the deductible Medicare pays 80 percent of the Medicare-approved cost of your medically necessary supplies and services. You would pay the 20 percent coinsurance payment. Once the deductible has been met, you cannot be charged to pay more than your 20 percent coinsurance amount and this is the case whether you pick up your diabetes supplies at a local st Continue reading >>

Medicare Announces Criteria Covering Dexcom G5 Mobile Cgm For All People With Diabetes On Intensive Insulin Therapy

Medicare Announces Criteria Covering Dexcom G5 Mobile Cgm For All People With Diabetes On Intensive Insulin Therapy

Dexcom is pleased to announce that the U.S. Centers for Medicare & Medicaid Services (CMS) has published an article clarifying criteria for coverage and coding of the Dexcom G5 Mobile system, the only therapeutic CGM under this CMS classification. People covered by Medicare who have either Type 1 or Type 2 diabetes and intensively manage their insulin will now be able to obtain reimbursement. "This is a new era and a huge win for people with diabetes on Medicare who can benefit from therapeutic CGM," said Kevin Sayer, President and Chief Executive Officer, Dexcom. "This decision supports the emerging consensus that CGM is the standard of care for any patient on intensive insulin therapy, regardless of age." According to CMS, therapeutic CGM may be covered by Medicare when all of the following criteria are met: The beneficiary has diabetes mellitus; and, The beneficiary has been using a home blood glucose monitor (BGM) and performing frequent (four or more times a day) BGM testing; and, The beneficiary is insulin-treated with multiple daily injections (MDI) of insulin or a continuous subcutaneous insulin infusion (CSII) pump; and, The patient's insulin treatment regimen requires frequent adjustment by the beneficiary on the basis of therapeutic CGM testing results. In order to be included in this category, the system must be defined as therapeutic CGM, meaning you can make treatment decisions using the device. Dexcom G5 Mobile is the only system approved by the FDA to meet that criteria. See the Medicare Administrative Contractor (MAC) website for instructions for individual claim adjudication. Coverage is effective for claims with dates of service on or after January 12, 2017. A link to the article on coding and coverage can be found at: . Continue reading >>

Medicare And Cgm Debate

Medicare And Cgm Debate

You may find it hard to believe, but continuous glucose monitors have been around for quite a few years not. Almost all private insurance carriers are not covering them for patients with type 1 diabetes. There has been a battle amongst those advocating for better technology access for patients and the Centers for Medicare and Medicaid Services for almost 10 years now in terms of coverage for a CGM. It’s an amazing step forward that those with diabetes are now living normal life expectancy. But the current coverage set up for those with diabetes in the Medicare system is limiting coverage on a lifesaving technology. For younger patients with diabetes on commercial / private health insurance plans, tools like brand name glucose meters and strips, CGMs, and even insulin pumps are covered for the most part. The technology isn’t without of reach for a majority of individuals. What’s even better is when an insulin pump goes out of warranty a new one can be ordered every four years. There may be some variety in insurance coverage but a vast majority of patients have access to all these supplies and devices. I recommend these articles: Medicare is Different In terms of coverage for insulin pumps, Medicare really makes patients jump through hoops before they will even consider it. They require that a patient undergoes a test to prove they are not making their own insulin and that they really need an insulin pump. Patients are not able to request one because they want to improve their management. Medicare will only pay for an insulin pump for individuals who quality every 5 years, so that means patients are spending one year using an insulin pump that is out of warranty. While this is a shocker, there are even limits on the types of pumps they will pay for. Let’s Talk Abo Continue reading >>

Asknadia: Why Medicare Covers Some Insulin Pumps

Asknadia: Why Medicare Covers Some Insulin Pumps

AskNadia: Why Medicare Covers Some Insulin Pumps I was thinking about getting an insulin pump, but I am worried that Medicare will not cover it. Why does Medicare cover insulin pumps for some people and not for others? Insulin pumps are covered under Medicare if you meet their insulin pump management criteria, insulin antibody test or C-Peptide test. If you are thinking about getting an insulin pump, this is what you need to do. Anytime someone asks me about going on an insulin pump; I recommend they speak to someone who is wearing a pump or go to an insulin pump support group. The wisdom you gain from exploring these two venues is invaluable. After speaking to people who wear a pump, you will either decide it is the best thing for your blood sugars or too labor intensive and might try something else to achieve better blood sugar levels. Working with Your Healthcare Professional Healthcare professionals are great at identifying who is best suited for an insulin pump. They know if you can benefit from using an insulin pump to achieve better blood sugars based on their experience with you and your medical chart. Start a discussion with your healthcare professional who knows you and has access to your medical history. Lets assume your healthcare professional thinks you will benefit from using an insulin pump because you meet the Medicare A or B criteria. Lets also assume you have had an opportunity to speak to people that wear pumps and are very excited about getting started in qualifying for one; the formula below is the process Medicare uses to evaluate insulin pump coverage requests. Medicare A Criteria is For New Insulin Pumpers 1- You must be on multiple injections and able to self-adjust your insulin for six months prior to going on an insulin pump. This means you t Continue reading >>

Medicare Coverage For Patients With Diabetes

Medicare Coverage For Patients With Diabetes

Go to: DIABETES: RISING MEDICARE POPULATION AND ECONOMIC BURDEN Considered by many to be an emerging pandemic, the increasing prevalence of diabetes in the United States population over the past half-century is a growing concern. According to the Centers for Disease Control (CDC), the total number of individuals reported to have diabetes in the United States has more than doubled from 5.8 million in 1980 to 14.7 million in 2004.1–3 Factors proposed to account for the increase of people in the United States diagnosed with diabetes include changing diagnostic criteria, improved or enhanced detection, increased awareness, growth in minority populations, obesity and lifestyle factors, and decreased mortality.4–6 A major increase in the prevalence and incidence of diabetes has been noted among Medicare beneficiaries age 67 or older. Between 1993 and 2001, the adjusted prevalence of diabetes cases per 1,000 individuals in the elderly Medicare population rose from 145 to 197. The highest prevalence rates were noted among minority groups. Between 1994 and 2001 the adjusted incidence of diabetes in beneficiaries age 67 or older increased 36.9%, from 27/1,000 to 37/1,000.6 By 2050, the number of people with diabetes is expected to increase by 165%, with the greatest increase expected among individuals age 75 or older.7 The economic burden attributed to diabetes has paralleled population trends. According to the American Diabetes Association (ADA), in 2002 direct medical and indirect expenditures attributed to diabetes in the United States were $91.8 billion and $39.8 billion, respectively. Individuals age 65 or older bore the majority of the estimated costs at $47.6 billion. Costs for insulin and delivery supplies, oral agents to lower blood glucose, and other outpatient medi Continue reading >>

Type 2 Diabetes: What Is It

Type 2 Diabetes: What Is It

Find Affordable Medicare Plans in Your Area The National Institutes of Health (NIH) defines diabetes as a condition where your body doesnt make enough of the hormone insulin, or doesnt use insulin properly. Insulin is a hormone produced by the pancreas that helps control the amount of blood sugar, or glucose, in the blood and helps it get to cells to give you energy. Type 2 diabetes is one of the most common forms of the disease, according to the Centers for Disease Control and Prevention. More than 29 million people in the United States have diabetes, according to a 2016 report by the National Institutes of Health. Thats about 9.3% of the population. Over a quarter of Americans aged 65 and over have diabetes. And about 95% of adults with this disease have type 2 diabetes. What are commontype 2 diabetessymptoms? Unlike type 1 diabetes, which often develops during childhood or young adulthood, the symptoms oftype 2 diabetesusually develop during middle age or later. According to the National Institutes of Health (NIH),type 2 diabetessymptomsinclude: Sores that wont heal, or are very slow to heal Keep in mind that not everyone experiences all of these symptoms; some people may have different signs of the disease. And some people dont notice any symptoms at all, according to the NIH publication Medline Plus. What are some possible complications oftype 2 diabetes? Untreated or uncontrolled diabetes can lead to complications with many of your bodys organs, such as your kidneys, eyes, and heart, according to the NIH publication Medline Plus. The NIH reports that people withtype 2 diabetesmay be at a higher risk (compared with those who dont have the disease) for: Damage to the eyes (diabetic retinopathy) including possible blindness Nerve damage in the feet and legs, which m 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 >>

Medicare Coverage For Diabetes Services And Supplies

Medicare Coverage For Diabetes Services And Supplies

Diabetes is a condition where your body lacks the ability to use blood glucose (blood sugar) for energy, according to the Centers for Disease Control (CDC). As a result, diabetics may have high blood glucose levels. In diabetics, the pancreas typically doesn’t make or use the insulin hormone efficiently. Your body uses insulin to turn sugar (glucose) into energy. Unused sugar can build up in your blood and cause both short-term and long-term problems. Diabetes can be diagnosed with a simple blood test. Many older Americans have type 2 diabetes, where your body doesn’t produce enough insulin or develops resistance to it, according to the CDC. However, even adults can get type 1 diabetes, which used to be called juvenile diabetes. Medicare covers certain medical services and supplies for individuals who have diabetes or at risk for this condition. Medicare coverage for diabetes screenings If you have Medicare and your doctor considers you at risk for diabetes, you may be eligible for up to two blood sugar screenings per year under Medicare Part B ; you don’t pay anything for the screening itself if you use a Medicare-assigned provider at a Medicare-approved facility. However, you may have to pay 20% of the Medicare-approved amount for the visit to the doctor’s office. Risk factors that may qualify you for a Medicare-covered diabetes screening include: High blood pressure History of abnormal cholesterol and triglyceride levels Obesity History of high blood sugar Family history of diabetes Older age (risk for type 2 diabetes increases with age) Reduced blood sugar tolerance High blood sugar levels when fasting Medicare coverage for diabetes patients If you’re diagnosed with diabetes, Medicare may cover services and supplies you will need to treat and control diabe Continue reading >>

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