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This blog is the first in a three-part series in which we discuss Medicare coverage for diabetes supplies.
Medicare is the U.S. health insurance for people age 65 and older and also for some younger individuals with certain disabilities. Medicare is made up of four parts:
Diabetes supplies and education are covered under Medicare Part B.
Blood glucose self-testing supplies include blood glucose meters, blood glucose test strips, lancet devices, lancets and glucose control solution.
However, if your doctor says it's "medically necessary," Medicare will cover additional test strips and lancets. For questions about diabetes supplies, contact Medicare at 800-MEDICARE (800-633-4227).
Tips for ensuring coverage:
Medicare also covers things like insulin pumps, insulin, and therapeutic shoes or inserts if you meet certain conditions. In the next couple blogs, I will try to address Medicare's coverage specifications for therapeutic shoes and insulin pumps.
Note that many states have insurance plans that also cover specific diabetes supplies. And, if you're eligible, Medicaid covers diabetes supplies.
Have a good week.
Nancy Klobassa Davidson, R.N.
Peggy Moreland, R.N.
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Al- call the #800 for the insulin pump company and ask to speak with the insurance representative, they deal with insurance and Medicare questions all the time. Or, call 1-800-MEDICARE.
My wife has been on an insulin pump for about 40 years. She has always got her insulin using plan D. She lost her plan D coverage this year.(2013)
So ths year she has been getting the insulin thru medicare part B. That's great but unfortunately medicare has rejected it each time. The doctor used procedure code J1817 . When I call medicare they agree that the insulin should be covered because it is dispensed by an external insulin pump. Does anyone know what exactly needs to be on the prescription.
Be aware that if you test 2 or more ("multiple times")Medicare requires a log to be completed with dates and times. If your doctor orders one time a day--no need. Be sure your doctor doesn't write for a "spread" (e.g. 1 - 2) or Medicare will bill for the higher number and you will be doing more paperwork. I discovered this the hard way and had to tell my doctor....NO AMBIGUITY if 1x a day is ok, just write 1x day please. Logs, paperwork, groan.
My wife is on medicare and has gestational diabetes. They are denying coverage. The doctor says testing is medically necessary.
What do we do???!
I am pre-diabetic and I received 100 test strips thru my plan just once. Now, I am told I am not covered because I have not been diagnosed as being diabetic. Was a mistake made the one time I received them or am I entitled to 100 every three months. Anyone out there have an answer?
My sister uses the insulin pen.Does Medicare part B,pay for it? She is paying alot of money for the pen.I told her, I think Medicare will pay for it.
Thank you. This was very quick, precise and very helpful. Thank you again.
Maintaining a blood glucose log is always a good idea, but proof is only required when using more test strips than Medicare allows. Medicare allows up to 100 test strips per month.
Today I received mandate from the pharmacy to supply them with a log to document the use of test strips paid for by Medicare. Is this a new requirement by the government? Thank you for any helpful information.
I was not aware that diabetic supplies were covered by Part B Medicare. I have been paying a big co-pay because I do not have part D. Did i misunderstand this blog?Even tho' I would still have to pay for my insulin it would be a help if I could get a break on my strips and lancets
Sharon: The insulin companies have patient fincancial assistance programs. Contact the insulin company for further information. You can also check their website for more information. You didn't mention what insulin you are on but NPH store brand can be as low as around $25 per vial the last we checked in early 2012(check with your local department stores).Ask your provider if that type of insulin is an alternative for you.
iam about to enter the dreaded donut hole with medicare part D and will not be able to buy my insulin. my doctor says i cannot go back to taking oral meds so does anyone know what my next options might be?
Ever since they came out with the insulin pen it has made life sooo much easier to inject insulin. I use the BD Nano needle with the pen and it is so tiny you don't feel anything. I hate needles but these guys work great. I also love the fact you don't need to keep the pens cool. It's so easy to inject why flying or traveling aboard now. And Medicare paids for them. So if you are tired using needles have your doctor put you on the pen...
I enjoy you columns & find them to be very helpful and informative. Keep it up! We need all the tips we can get.
I'm still looking for that long-lost recipe for the great spice cabbage soup. It's based on V-8 & is fabulous...lost the recipe though. Help!
Medicare covers insulin pump supplies (not sure about the pump itself) if you meet certain criteria, even if you're Type 2. Your fasting C-peptide must be quite low (I believe it must be below 0.8) and you need to have a fasting bg done at the same time that is below 225.
My 21 year old son was diagnosed with Type 1 Diabetes right before he turned 13 years old. He does not have his own medical insurance, but is currently covered under his dad's insurance, which has an extremely high deductible. My son is working 30 hours a week at minimum wage. He will not be able to afford his medicine when he moves out on his own. Could he be eligible for Medicare or Medicaid?
I have a friend that is type 2 but cant control her high blood sugar.
Her doctor says that she would benefit from an insulin pump.
She says Medicare won't pay for an insulin pump. She says she can't afford I do not think she is getting the right information.
Medicare also covers prescribed insulin that is used in a pump. I hope they will someday cover the continuous glucose monitor and glucose sensors.
This is a very useful post! Thank you. I am looking forward to the next one about coverage of insulin pumps and related supplies, like Continuous Glucose Monitors--both of which I use.
Can you devote some space to how medicare reimbursement meshes with private prescription and health insurance when medicare is either the primary or secondary insurance?
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