Ways You Could Save On Blood Sugar Test Strips With Medicare
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. And every blood sugar test uses one test strip. Sometimes extra tests may be needed, such as when starting a new medication or adjusting an insulin dose.
Prodigy Diabetic Supplies Medicare And Insurance Coverage
Blood glucose testing is an important part of diabetes management. Most insurance companies and Medicare/Medicaid will pay for blood glucose testing supplies. With private insurance or managed care, patients will most likely be asked to pay a co-pay to cover part of the cost of the supplies. Medicare pays for 80% of supplies once the patient has met their yearly deductible and the patient is responsible for the remaining 20% of the cost. See the www.Medicare.gov site for a full explanation of how your blood glucose testing supplies are covered. Prodigy Diabetes Care is contracted with certain insurance providers and state Medicaid programs, which may make the Prodigy brand products available to those individuals at a lower co-pay or no co-pay depending on the program.Continue reading > >
Blood Glucose Test Strips: Reimbursement Conditions
The reimbursable quantity of blood glucose test strips is subject to certain rules. The Public Prescription Drug Insurance Plan covers the purchase of a limited number of strips per year.
We determine the reimbursable quantity of strips based on to your health condition, according to your risk of hypoglycemia. The maximum number of strips is calculated per 365-day period as of the 1st purchase of strips. The health professional in charge of your follow up may allow you to obtain additional strips per 365-day period for specific health problems.
Reimbursable quantity of strips depending on your health condition
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What Brand Of Diabetic Test Strips Does Medicare Cover
Medicare covers a number of common blood glucose monitors and their test strips. Examples include OneTouch and Accu-Chek. If you prefer a particular brand, your doctor can write the prescription saying Do Not Substitute.
If you have Medicare Advantage, your plan may have preferred vendors or dictate what diabetes testing brands are covered. You should contact your insurance company to determine what brands your insurance company covers. This will ensure youll be reimbursed for your blood glucose monitor and testing strips.
Under Medicares rules for mail-order suppliers, the suppliers must provide the same options for blood glucose monitors to those with Medicare as they do for customers with other insurance types.
How Much Will You Pay For Diabetes Supplies Through Medicare Part B
After you have met the Part B deductible, youll pay co-insurance of 20% of the Medicare-approved payment rate for necessary supplies and services. Many Medicare beneficiaries have additional coverage that may help them pay the co-insurance.
All diabetes supplies are reimbursed at the same rate under Medicare Part B.2,3 You wont pay more to get quality Accu-Chek diabetes products available at all major retail pharmacies.
You can also receive your diabetes supplies through the Medicare national mail-order program, although mail-order suppliers may offer fewer brands than your local pharmacy. If the supplier you contact doesnt carry Accu-Chek products, visit your local retailer to fill your Accu-Chek Guide test strip prescription.
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1Centers for Medicare and Medicaid Services. Medicares coverage of diabetes supplies and services. Available at: . Accessed August 17, 2018.
2Medicare. Medicares national mail-order program for diabetes testing supplies. Available at: . Accessed August 16, 2018.
3Accu-Chek test strips are covered when medically necessary for the patient and prescribed by a physician.
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What Medicare Members Would Pay
CMS had originally proposed three different categories of payment for those using the different types of CGM technology. The logic was that some didnt require fingersticks so users wouldnt need reimbursement for test strips, as would other systems that still require calibration . It also viewed the FreeStyle Libre flash glucose monitoring a bit differently than other tech, like Dexcom and Eversense. So it proposed different reimbursements for those varying styles of tech.
However, CMS has re-thought that move after public outcry. In its new December 2021 rule comments, the agency noted this:
After consideration of public comments, CMS does not believe it is necessary at this time to further stratify the types of CGMs beyond the two categories of non-adjunctive and adjunctive CGMs.
Whats The Best Way To Buy Diabetic Supplies
Who is this for?
If you have diabetes, this page will explain how to buy supplies through your Medicare plan.
When youre managing diabetes, medical supplies like insulin and blood glucose test strips can be a big part of your life. But they dont have to be a big expense.
Our Medicare Advantage plans cover diabetes monitoring supplies with no copay. Diabetes monitoring supplies include things like blood glucose monitors, blood glucose test strips, lancet devices, and insulin pumps.
Our plans also cover therapeutic shoes and inserts with no copay.
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What If I Don’t Have A Diabetes Test Strips Supplier Locally
If you dont have access to a pharmacy that accepts assignments from Medicare for diabetes testing supplies, you can order supplies through Medicares mail-order program. These enrolled suppliers accept assignment from Medicare, charge you the 20% copayment and accept reimbursement from Medicare directly.
Medically Necessary Quantities Of Diabetic Supplies
Usual Utilization
- For members with diabetes who are not currently being treated with insulin injections, up to 100 test strips and up to 100 lancets every 3 months are considered medically necessary.
- For members with diabetes who are currently being treated with insulin injections, up to 300 test strips and up to 300 lancets every 3 months are considered medically necessary.
High Utilization
Code Code Description
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New Medicare Coverage Requirements Make Cgms More Accessible
The diabetes community is celebrating a huge win! Beginning on July 18, 2021, Medicare will permanently eliminate the requirement of the four-time-daily fingerstick in order to qualify for coverage of a continuous glucose monitor .
This requirement was an unnecessary barrier for Medicare beneficiaries, delaying access to this effective technology for individuals with diabetes.
CGMs provide users with real-time, dynamic information about their blood glucose levels around the clock and alerts to prevent dangerous high or low glucose levels, leading to better diabetes management and ultimately improved health outcomes. One out of five people on Medicare have diabetes, and the elimination of the fingerstick requirement means Medicare beneficiaries with diabetes will have easier access to this critical technology.
What does this mean for you? If you already have coverage for your CGM, great! If youre looking to get one and receive your health insurance through Medicare, after July 18 there will be a simplified, fingerstick-free approval process. The out-of-pocket cost for your CGM will depend on a few factors, like what your Medicare benefit plan looks like, where youll get your device, etc. Talk to your doctor and a Medicare representative to determine what it will cost for you.
Medicare Coverage Of Glucose Monitors
Under Original Medicare , Part A covers health-care expenses you incur as an inpatient in a hospital, while Part B covers your outpatient care, including some glucose monitoring supplies and durable medical equipment. Medicare does not generally cover continuous glucose monitoring, which involves a sensor inserted under your skin for several days to a week.
If your health-care provider recommends a different way to monitor your blood sugar other than the finger-stick glucose monitor, you might want to check with Medicare to see whether its covered. You can reach a Medicare representative 24 hours a day, seven days a week, if you call 1-800-MEDICARE . TTY users can call 1-877-486-2048. If you have a Medicare Advantage plan, call your plan to ask about this coverage.
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What Diabetic Supplies Are Covered By Original Medicare
Original Medicare Part B covers some diabetic supplies, including:
- Blood sugar 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
- Therapeutic shoes or inserts
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 pens, syringes, or needles
- Alcohol swabs or gauze
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Other Useful Information On Diabetic Supplies
- Generally, you pay 20% of Medicare-approved amounts for your supplies, and the Medicare Part B deductible applies.
- Make sure you refill your supplies in a timely manner, and only accept supplies you have requested. Medicare wont pay for supplies you didnt order for example, if a supplier automatically sends you items, you cannot get reimbursed by Medicare.
- You may rent or purchase certain diabetic supplies. For more information, call 1-800-MEDICARE . TTY users call 1-877-486-2048. Customer service representatives are available 24 hours a day, seven days a week.
- Ask if the supplier is a participating supplier in the Medicare program before you get durable medical equipment for diabetes. If the supplier is a participating supplier, he or she must accept assignment. If the supplier is enrolled in Medicare but isnt participating, he or she has the option to accept assignment or not. If a DME supplier doesnt accept Medicare assignment, there is no limit to what you can be charged. You also may have to pay the entire bill at the time you get the DME.
- All Medicare-enrolled pharmacies and suppliers must submit claims for diabetic testing supplies. You cant send in the claim yourself.
Blood Glucose Monitors With Integrated Lancing/blood Sample
Aetna considers blood glucose monitors with integrated lancing/blood sample medically necessary DME in persons with diabetes who meet either of the following criteria:
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How Much Does Accu Chek Test Strips Cost
The Accu Chek Blood Glucose Monitor costs somewhere from $600 to more than $1,000. Accu Chek Test Strips may cost $0.58 per strip.
Most of the time, Accu Chek Test Strips cost $16 for 25 strips, $25 to $30 for 50 strips and $50 for 100 strips.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Free Onetouch Verio Reflect Meter For Aetna Medicare Advantage Prescription Drug Plan Members
Introducing the OneTouch Verio Reflect meter! This new high-tech, high-touch product is available to Aetna MAPD members at no cost from LifeScan, our exclusive provider of diabetes meters and supplies. These members are eligible for one free meter per year. Now may be a good time for members to upgrade their diabetes meter.
The OneTouch Verio Reflect meter:
- Takes less blood to obtain accurate readings
- Has a user-friendly backlit display, featuring glucose readings on a range to indicate near-high or near-low blood sugar levels
- Is the only meter to provide real-time messaging with guidance, insight and encouragement based on blood glucose results
- Allows the option to connect to the free OneTouch Reveal® mobile app via Bluetooth® technology, making it easy to share and discuss results with family and health care providers. Members can sync data seamlessly from the OneTouch Verio Reflect meter to their smartphone to view patterns identified in blood glucose summaries.
If you have questions or if youd like to know how Aetna Medicare Advantage plan members can order a OneTouch Verio Reflect system kit at no additional cost, visit OneTouch.OrderPoints.com and input brochure code 123AET200. Or call LifeScan at and provide brochure code 123AET200.
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Local Coverage Determination Guidance Covering Blood
As a review of the LCD guidance cited earlier will show, each of the applicable LCDs specify the coverage, payment rules, and documentation requirements that must be met in order for test strips and lancets to qualify for coverage by Medicare. Importantly, all four LCDs limit coverage to 100 test strips and 100 lancets per Medicare patient per month if a Medicare beneficiary is insulin dependent. This quantity is intended to permit insulin-dependent beneficiaries to test their blood glucose levels up to three times per day. When a Medicare beneficiary is not insulin dependent, a contractor may only cover up to 100 test strips and 100 lancets every three months.
In certain instances, a Medicare beneficiary may need to assess their blood glucose levels more frequently than an LCD generally permits. Medicare permits more frequent testing as long as it is medically necessary and appropriate in light of a beneficiarys clinical profile and medical needs. The invoice submissions associated with these situations are sometimes referred to as high utilization claims. Medical documentation supporting the more frequent use of test strips must be maintained in a treating physicians records in order to support a patients high utilization of testing supplies.
Why Medicare Will Cover The Medtronic Cgm Now
Up until now, Medtronic has been the only CGM company without Medicare coverage.
The other CGM products available Dexcom G5 and G6, Abbott FreeStyle Libre 2, and the implantable Eversense CGM from Senseonics and Ascensia have been covered for years. But Medtronic is the only company that did not get a non-adjunctive designation , which wouldve allowed the CGM to be used for insulin dosing and treatment decisions without a need for confirmatory fingersticks.
That so-called dosing claim was a new category created by the Food and Drug Administration , its first attempt to distinguish the different levels of CGM technology that existed at that time in 2017. The Dexcom G5 was the first to obtain that status and be known as a therapeutic CGM, followed by the Abbott FreeStyle Libre and then Eversense 90-day implantable CGM.
To date, Medtronics Guardian CGM remains the only one that requires fingerstick calibrations and doesnt have Medicare coverage.
But CMS is now changing that, lumping Medtronics device into the same category as the non-adjunctive devices so that they are all covered by Medicare.
Importantly, the new Medicare policy does not include Medtronics stand-alone Guardian Connect CGM system. Instead, it only allows for Medicare coverage of the Medtronic CGM when it is combined with the companys MiniMed insulin pumps.
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Predx Diabetes Risk Score
The PreDx® Diabetes Risk Score test is a multiple-biomarker test to identify high-risk individuals who might develop diabetes within 5 years. Using a proprietary algorithm combines seven biomarkers to quantify the risk of developing diabetes within 5 years. The model also includes age and sex. A diabetes risk score between 1 and 10 is calculated, with a higher score indicating an increased likelihood of developing diabetes within 5 years. Since the biomarkers are a combination of proteins and metabolites, they are measured using several different methods: ion-exchange high-performance liquid chromatography , chemiluminescent immunoassay , enzymatic , immuno-turbidometric assay , and an enzyme-linked immunosorbent assay . The PreDx DRS is used for patients who do not have type 2 diabetes but are at increased risk for developing this condition. Patients to be considered include those with impaired fasting glucose, metabolic syndrome, or other risk factors, including family history, age > 45 years, presence of obesity, coronary artery disease, hypertension, low high-density lipoprotein cholesterol , increased triglycerides, and belonging to an ethnic group with a higher prevalence of diabetes . Currently, two laboratories offer the PreDx DRS multibiomarker test. However, all testing is done at one of these facilities, Tethys Bioscience Inc.
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How Does Medicare Treat Durable Medical Equipment
Medicare treats glucose monitors and blood sugar test strips as durable medical equipment under Medicare Part B. If your physician prescribes glucose monitoring at home, your durable medical equipment costs are generally covered at 80 percent of the Medicare-approved
amount, once your deductible is met.
Keep in mind, however, that under Medicare Part B, your glucose monitoring equipment and supplies will only be covered if both your health care provider and DME vendor accept Medicare assignment. If you live in area affected by Medicares Competitive Bidding Program, you generally need to use a Medicare-contracted supplier.
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