Medicare Covers Diabetic Supplies - But It's Not Automatic
Several years back when Charlie Adams was first diagnosed with Diabetes, he learned to use special equipment and suplies to regularly test his blood sugar. As the cost of living has increased, and Charlie's pension has stayed more or less the same, the supplies necessary for living well with diabetes are beginning to cost him more per month than he can now afford. Recently Charlie cut back to testing his blood just twice a day instead of the four times his doctor wants him to check.
In order to properly monitor his blood glucose, Charlie needs a glucometer (a blood glucose testing meter), special single-use blood testing strips to use in his meter, a finger-pricking device to quickly obtain a small drop of blood for testing purposes, and tiny needles called lancets to use in the pricking device. He uses alcohol wipes to prepare his finger before pricking for blood, and now that he has been prescribed insulin, he uses syringes to give himself regular injections.
All this equipment can become very costly, and we haven't even talked about the cost of Charlie's oral medication and insulin. Blood testing strips, used in the glucometer, can easily cost $1 or more per strip. If someone with diabetes must test their blood glucose level three or four times daily, this can become prohibitively expensive. In order to reduce these expenses, some seniors cut back on the number of times they check their blood sugar each day. This can make it difficult to manage diabetes.
Charlie's local independent pharmacy is not fond of the Medicare reimbursement system, so when Charlie first presented his prescriptions several years ago, they simply filled them and charged Charlie. Somehow, Charlie missed the notice that Medicare will help pay for his necessary monitoring supplies, and he never pursued this insurance. He has spent several thousand dollars over the years that won't be retroactively reimbursed, but can certainly be covered going forward.
If your senior did not know about the assistance offered by Medicare, or never followed through with the doctor to apply for coverage, he or she is spending far more than necessary on diabetic supplies. Getting them covered might make a big difference in the amount of available spending money every month!
What Blood Sugar (Glucose) Testing Supplies and Equipment Medicare Covers
Traditional Medicare covers the following for everyone with diabetes who has Part B, whether they use insulin or not. Medicare will cover 80% of the Medicare-approved amount after the patient has paid the yearly Part B deductible. The patient is responsible for the remaining 20% of the cost after paying the annual deductible. Many private Medicare supplement plans will cover the patient's 20% co-payment. Some even will cover the annual Part B deductible. Check with your plan:.
• Blood sugar monitors
• Blood sugar test strips
• Lancet devices and lancets
• Glucose control solutions for checking the accuracy of testing equipment and test strips
• For those who use an insulin pump. Medicare Part B covers both the pump and the insulin under Part B.
The amount of supplies covered does depend on whether the patient does or does not use insulin. Those who use insulin should be covered for up to 100 test strips and lancets every month, and one lancet device every 6 months. Those who do not use insulin should be covered for up to 100 test strips and lancets every 3 months, and one lancet device every 6 months.
If the patient's physician states in writing that it is "medically necessary," Medicare will often allow coverage for additional test strips and lancets.
Medicare and Insulin Administration Supplies
Supplies used for administering insulin are no longer included under traditional Medicare Part B insurance. Since the advent of private Medicare Part D drug plans, the following supplies have been covered by these plans. Each Part D plan will offer their own unique coverage for insulin, as well as the following supplies for its administration. Co-insurance, co-payments and deductibles may apply, depending on the plan:
• alcohol swabs
• inhaled insulin devices
What Do You Need From the Doctor to Get Diabetic Supplies Covered by Medicare?
Anyone who wants to have their testing and injecting supplies covered by Medicare will have to have a very detailed prescription from their doctor. Some pharmacies have a form for the doctor to complete so that no mandatory item is missed. The doctor's prescription must explicitly state:
• Whether you have diabetes
• What kind of blood sugar monitor you need and why you need it (If you need a special monitor because of vision problems, your doctor must explain that.)
• Whether you use insulin
• How often you should test your blood sugar
• How many test strips and lancets you need for 1 month
Medicare requires a new detailed prescription from the doctor for lancets and test strips every 12 months.
You must get supplies from a pharmacy or supplier that is enrolled in Medicare. If you use a pharmacy or supplier that does not participate in Medicare, your supplies will not be covered.
For some obscure reason a patient is not permitted to submit a claim to Medicare for blood sugar (glucose) monitor test strips. The pharmacy or test strip supplier must submit these claims. If the pharmacy or supplier accepts assignment, Medicare will pay the pharmacy or supplier directly. the patient should only be required to pay the coinsurance amount.
For those who are insured by a Medicare Part C plan, such as Medicare Advantage, comparable coverage should be available. Check with your senior's individual plan.