Which Diabetic Supplies Are Covered By Medicare
For those with diabetes, Medicare Part B covers three main areas of diabetic supplies: blood sugar self-testing equipment and supplies, insulin pumps, and therapeutic shoes or inserts. For these areas, Medicare typically covers 80% of the visit and you will pay 20% if you do not have coinsurance. These costs can also go toward the Part B deductible.
Medicare Part B also covers certain diabetic screenings and services.
If you have an insulin pump, Medicare Part B covers the pump as well as the insulin under durable medical equipment instead of as medicine under Part D, explains Lindsey Hudson, APRN, NP-C, and certified diabetes care and education specialist working in Charleston, South Carolina, and a member of the SingleCare Medical Board.
Medicare Part B also covers certain diabetic screenings and services. For the supplies, screenings, and services below, note that Medicare consumers may have to pay coinsurance, copays, and/or deductibles depending on their plan.
Do Medicare Advantage Plans Cover Diabetes Supplies And Medications
In short, yes!
Unlike traditional Medicare, Advantage Plans have their own specific costs for different equipment, supplies, and Medications.
Each plan is different and coverage amounts and limits are different.
When searching for a plan, just like for Part D, you want to enter all of your Medications to see what is covered at what amount.
Medicare Advantage plans, also commonly known as Part C of Medicare, are plans sold by Medicare-approved private insurance companies to cover all of your Part A and Part B services.
Advantage plans usually include prescription drug coverage and sometimes other benefits not covered by Medicare, like dental, vision, and hearing.
We talked about Part C in more detail in another post, which you can read here.
Medicares Diabetes Prevention Program
Medicares Diabetes Prevention Program is offered to Medicare beneficiaries once per lifetime and includes education and coaching focused on making healthy lifestyle changes.
You qualify for this program if you have never been diagnosed with diabetes, have high blood sugar levels, and have a high body mass index .
The program is six months long, is comprised of 16 group sessions with a behavioral coach, and includes:
- Nutrition, fitness, and weight loss tips and advice
- Support of fellow group members
- Training that is focused on making lasting lifestyle and behavior changes
You may be eligible for additional sessions and support if you successfully complete the program and maintain a healthy lifestyle.
If you meet the eligibility requirements, there is no cost to you for participating in this program.
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Options For Coverage Under Medicare
When you are eligible to enroll in Medicare, you have two basic options.
The first option is to enroll in Original Medicare Parts A and B, which is managed by the federal government. Youll need to enroll in a Part D drug plan separately from your enrollment in Original Medicare since the Part D portion of the benefit is offered only through commercial insurers.
Depending on your income, your costs for Part D coverage may be significantly reduced. In order to receive this reduction, you have to apply for the extra help.Theres no downside for applying and you can re-apply every year since your income and the qualifying criteria change each year.
For 2021, some part D plans will offer $35 insulin copays. Called the Senior Savings Model, you will need to enroll in a plan that offers this in order to get these savings. For more information about these plans, see our blog post, Remember! Enroll in Medicare Part D plans that cap insulin costs at $35.
If you enroll in Original Medicare, you can also purchase a separate Medicare supplement or Medigap policy that can cover your deductibles and cost-sharing under Parts A and B in return for a fixed monthly premium. As explained below, the ability to purchase a Medigap policy could be critical for many people with T1D and the timing of when you purchase Medigap coverage is very important.
The authoritative place for evaluating available options for Medicare coverage is the Medicare Plan Finder.
How To Get The Brands You Need Covered By Medicare
The rules of Medicare states your doctor can prescribe the specific item or brand of diabetes testing supplies you need. Your doctor must put this in writing and also make a note in your medical record indicating that you need this exact item or brand in order to avoid an adverse medical outcome.
Once your doctor does this, a Medicare contract supplier is required, according to Medicare.gov to do one of the following:
- Give you the exact brand or mode of delivery of the item or service your doctor authorizes for you.
- Help you find another contract supplier that offers that brand or mode of delivery.
- Work with your doctor to find an appropriate alternative brand or mode of delivery and get a revised written prescription.
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Does Medicare Cover Diabetic Test Strips
Yes, Part B pays for diabetes supplies such as test strips. You may qualify for as many as 300 test strips every three months if you need insulin. Patients not using insulin may be eligible for up to 100 test strips every three months.
There may be limits on how many and how often you may get these supplies under your plan. Part B also covers supplies such as blood-sugar monitors and test strips.
Other DME supplies like lancets, glucose control solutions, and devices have coverage. Your doctor must document that Medicare must allow any extra strips or lancets. Moreover, documentation of how often youre treating yourself is necessary.
How Can I Save Money On My Diabetes Medication
Medication prices are a concern for people across the UnitedStates, and especially for those with diabetes. There are several ways that youcan try to bring down your medication expenses.
- Part D Drug Plans: Part D Prescription Drug plans will help pay some of the costs of your medication. You should shop your plan every year during the Annual Enrollment Period, because the plans can change their coverage details. The plan thats the best for you this year might not be the best next year.
- Medication Management Therapy: Medication Management Therapy is designed to ensure that youre only on the medications that you need, that theyre all working properly, and that youre not spending more than you need to.
- Search for Rebates: Some manufacturers offer rebates or discounts on their products. You can find them by searching the name of your medication, followed by rebate.
- Speak with Your Doctor: If youre having issues affording your medications, your doctor may be able to help. For instance, they may have samples they can give you, or they may be able to prescribe you a higher dosage on pills that can be split in half. This would allow you to save money because you wouldnt need to refill your prescription as often.
Treating diabetes can be difficult and expensive, soMedicare offers a variety of services to help. If you have diabetes, you shouldspeak with your doctor to see what services are available to you.
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Indiana Medicaid For Members
Beginning January 1, 2011, a Preferred Diabetic Supply List will be implemented. You will need to start using one of the blood glucose monitorslisted in the table below. If you have a blood glucose monitor thatis not on the list below, you will need to speak with your doctorto get a new prescription for one of the blood glucose monitors andtest strips listed below. New blood glucose monitors and teststrips will be provided at no cost to you. If you alreadyhave one of the blood glucose monitors listed below, you do notneed to do anything. What if I need a monitor not on this list? If you have a medical condition that prevents you from using oneof the blood glucose monitors listed above, you or your pharmacywill need to speak with your doctor and ask him to request a priorauthorization for a different blood glucose monitor and teststrips. You may continue to use the same provider for your diabeticsupplies as you do now, and you will continue to receive theseproducts at no charge to you. If you have questions about this change, please contact theIndiana Health Coverage Programs Members Hotline at1-800-457-4584. If you have questions about any of the products on the PDSL,please contact the manufacturer for that product .The Abbott Diabetes Care Product Support Line and Roche DiagnosticsCustomer Care Center are available 24 hours a day, seven days aweek for product assistance.Continue reading > >
Coverage For Diabetes Supplies And Screenings
Medicare Part B the medical insurance arm of Medicare covers durable medical equipment and supplies such as blood sugar monitors, test strips and lancets. Part B also covers insulin pumps and therapeutic shoes or inserts.
Some supplies, like continuous glucose monitors, require additional approval from your doctor in order to receive coverage, according to the Centers for Medicare & Medicaid Services. There are also limits on the number of supplies covered by Medicare. For example, people who use insulin are eligible to receive more test strips and lancets than those who don’t. Always check first with your doctor to make sure any supplies you need will be covered by your plan.
In addition to durable medical supplies, Part B also covers certain diabetes screenings, tests, self-management trainings and medical nutrition therapy.
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How To Get Diabetic Supplies Through Part B
In order to receive coverage for diabetic supplies under Part B, you must have a prescription from your doctor. To ensure coverage, the prescription must include:
- That youve been diagnosed with diabetes.
- What type of blood glucose monitor and test strips you need.
- How often you should test your blood sugar.
- Whether or not you use insulin.
- How many test strips and lancets you need each month.
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Finding Approved Pharmacies And Suppliers
For supplies to be covered, Medicare requires you to get supplies from participating providers that accept assignment. This means they accept Medicare set payment rates.
If you use a provider that doesnt accept assignment, you will be responsible for all costs. The provider may charge a higher rate than the Medicare accepted rate.
Many supplies such as needles, lancets, and test strips are available at participating pharmacies. Some pharmacies also carry CGMs. You can check with your preferred pharmacy about what supplies they carry and if they accept assignment.
Some diabetic equipment, nutritional therapy, and shoe inserts/special footwear are available through durable medical equipment providers. Youll need prescriptions from your doctor for all supplies and equipment.
Diabetes is a condition in which blood sugar levels are high because the body either doesnt produce enough insulin or doesnt use/produce the insulin effectively , or develops temporary insulin resistance during pregnancy.
Risk factors for diabetes can be different for each type, but family history, age, race, and environmental factors may all impact the condition.
Its important to follow your doctors guidance on medications, blood sugar testing, lifestyle, and diet management.
What Brand Of Diabetes Supplies Is Covered By Medicare
There are a number of brands of diabetes supplies that are covered by Medicare, specifically:
However, not all brands are covered by Medicare, so check your coverage before purchasing any supplies. You can ask your doctor, pharmacist or supplier to check for you, or contact Medicare directly.
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Medicare Diabetes Prevention Program
Medicare offers a health behavior change program called the Medicare Diabetes Prevention Program. The idea is to help you prevent the onset of type 2 diabetes. Part B covers the entire cost when you meet the program requirements.
The following must apply for Part B to pay for the Medicare Diabetes Prevention Program:
- A BMI of or above 25 or 23+ if youre Asian
- Never diagnosed with type 1 or 2 diabetes
- Never participated in the program before
- Received a test result between 5.7 and 6.4%
- Never diagnosed with End-Stage Renal Disease
After joining, the program starts with 16 core sessions that you receive for six months. Each session is in a group setting. The benefits of the program are to help change long-lasting behaviors. The program teaches tips on how to exercise more and managing your weight. Get support from people with like-minds and goals.
Diabetes Coverage Under Medicare Part B
Medicare Part B covers services provided by a doctor, nurse, or similar professional on an outpatient basis. It also includes certain durable medical equipment but does not typically include medications, including insulin. Medicare Part B covers the following services:
The absence of insulin from this list seems like an enormous oversight. Luckily, thats where Medicare Part D comes in.
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Which Diabetes Services And Supplies Does Medicare Cover
Medicare Part B and Part D cover many diabetes services and supplies. You may first need to pay a deductible, copayment, or coinsurance. Some services are free if your doctor orders them.
Medicare Part B helps pay for
- diabetes screening tests for people at risk of developing diabetes
- Women, Infants, and Children
The Social Security Administration can provide financial help through two programs
- SSDI pays a monthly amount to people who cant work and have paid enough Social Security taxes. If an illness or injury keeps you out of work for at least a year, SSDI payments may be an option.
- SSI pays a monthly amount to disabled children and adults who earn little and dont have many financial assets. A person who gets SSI may be able to get Medicaid and food stamps through the Supplemental Nutrition Assistance Program , too.
Read more about both SSDI and SSI and how to apply at ssa.gov or by calling 18007721213, TTY: 18003250778.
WIC serves mothers and children who are at risk for poor nutrition or hunger. This includes low-income women who are pregnant, breastfeeding, or recently had a baby, as well as infants and children up to age 5. Pregnant women who have gestational diabetes may qualify for help through the WIC program. WIC provides
- supplemental foods
Learn more about WIC online, or call the WICs headquarters at 703-305-2062.
Does Medicare Advantage Cover Diabetic Supplies
When it comes to diabetic supplies covered by Medicare, itâs important to keep in mind that Original Medicare covers most basic diabetes suppliesâincluding annual diabetes wellness checks, testing supplies, and insulin pumps. You may still have to pay a copay, though, and you may not get full coverage for all of the supplies you need or want. A Medicare Advantage plan may offer broader coverage, depending on your diabetes care needs.
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When It Comes To Diabetes What Does Medicare Advantage Cover
In order to understand Medicare Advantage diabetes coverage, itâs important to first understand what Original Medicare covers for diabetes. The Centers for Medicare & Medicaid Services reports that Original Medicare offers coverage many basic diabetes supplies, including:
- Annual diabetes prevention, screening, and wellness checks
- Blood sugar monitoring equipment such as lancets and blood glucose monitorsâwith limits on which supplies you can use or how often you can buy them
- Durable insulin pumps and the accompanying insulin, under certain conditions
- Diabetes-related foot care for those who have peripheral neuropathy and a loss of protective sensation, including foot exams as well as orthotic diabetes shoes and inserts
Medicare Advantage plans are an alternative to Original Medicare. Advantage plans are supplied by private companies that must follow Medicareâs rules and regulations. While all Advantage plans must offer all of the benefits of Original Medicare, they may come with different rules, costs, rights, protections, and options.
Many Medicare Advantage plans provide benefits you cannot get with Original Medicare. According to the Centers for Medicare and Medicaid Services, some Medicare Advantage plans cover additional diabetes supplies and services, including:
With Medicare Advantage, youâll also have an annual out-of-pocket limit that may help you spend less on health care.
Medicare Coverage For Diabetes Patients
If youre diagnosed with diabetes, Medicare may cover services and supplies you will need to treat and control diabetes, such as those listed below.
- You might have to use certain Medicare-approved suppliers to get Medicare coverage see the Medicare.gov supplier directory.
- Original Medicare include only limited prescription drug coverage. You can get this coverage through the Medicare Part D program, either through a stand-alone Medicare Prescription Drug Plan or through a Medicare Advantage Prescription Drug plan.
Insulin and anti-diabetic drugs: Medicare Part D Prescription Drug Plans or Medicare Advantage Prescription Drug plans may cover insulin and prescription drugs to control your diabetes. To be covered under Part D, the insulin must be injectable, not administered through an insulin pump or infusion . Youd pay the Medicare plans copayment or coinsurance, and a deductible may also apply.
Diabetes supplies for insulin: Medicare Part D may cover diabetes supplies needed to inject insulin, including syringes, needles, alcohol swabs, gauze and inhaled insulin devices. You pay the Medicare plans coinsurance or copayment. These diabetes supplies may be subject to a deductible under your Medicare plan. Please note that your out-of-pocket costs may differ from one Medicare Prescription Drug Plan to the next.
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