Medicare Part B Covered Diabetes Testing Supplies
Part B covers a number of blood sugar self-testing supplies and equipment, even if you dont use insulin. These include:
- Blood sugar monitors
- Lancet devices and lancets
- Glucose control solutions
These supplies are considered durable medical equipment, and the actual amount of supplies that are covered varies depending on whether or not you use insulin. For example, if you use insulin, you may be able to get up to 300 test strips and 300 lancets every three months, but if you dont use insulin you may only be able to get up to 100.
If your doctor says its medically necessary, Medicare will cover additional test strips and lancets.
Test strips can be used to help monitor certain substances in the blood. They are small, single-use pieces of paper-like substance that you place one or two drops of blood on, and insert into a testing device. These devices provide results within seconds, and you can address any concerns regarding blood glucose levels.
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.
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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How Can I Get An Affordable Continuous Glucose Monitor
People who arent eligible for a continuous glucose monitor through Medicare may still be able to access an affordable device. Start by checking your health insurance to see if monitors are covered.
If you cant get a monitor through health insurance, you can try contacting the manufacturers. Many companies offer financial assistance to qualifying customers to help them access monitoring technology, including free trials and ongoing discounts for supplies.
Speak to your doctor if you want to try a continuous glucose monitor. Some doctors have stocks of supplies that theyre willing to share, and clinics may have professional continuous glucose monitors that they loan out. These are used for a short time to get a snapshot of your glucose data and gauge the effectiveness of your diabetes management.
Finally, you can look for an affordable supplier. More monitoring systems are becoming available through pharmacies, and these are generally less expensive than ordering direct through manufacturers.
Prodigy Diabetes 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 these program beneficiaries at a lower co-pay or at no out of pocket cost depending on the program.
Prodigy Diabetes Care, LLC
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How Can I Get Free Diabetic Supplies
In Canada, the following programs and services may provide assistance for diabetes medications and supplies:
Cgm Use And Inhaled Insulin
Along with this recent CGM policy change, Medicare has also expanded coverage for inhaled insulin Afrezza.
Originally, Medicare would not pay for both Afrezza and CGM technology, meaning that someone wanting to use either of these for their diabetes management would have to choose.
The restriction was in the fine print. Medicare documentation previously defined insulin users only as people using either multiple daily injections or using an insulin pump. But this policy change requested by Afrezza-maker MannKind Corp. has now amended the definition to include someone taking an inhaled insulin as an alternative.
This is a win-win for Medicare patients and providers that serve those patients, said Dr. Stella Ilyayeva, an endocrinologist in New York. In 2020, almost two-thirds of T1D Afrezza patients were utilizing a CGM concomitantly. I anticipate this change will open up more doors for the population of Afrezza users.
This rule change also takes effect on July 18, 2021.
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What Does Medicare Pay For Diabetes Supplies And Services
In general, Medicare pays 80% and you pay 20% of the Medicare-approved amount for diabetes supplies and services covered by Part B after the yearly deductible is met. Your percentage share of the cost is called coinsurance.
You may pay a coinsurance amount or a copayment for items covered by Part D. What you pay depends on the terms of your specific Part D plan.
Some services, such as medical nutrition therapy and A1C tests, may be provided at no additional cost to you.
Medicare Advantage plans cover diabetes supplies and services, too, and often additional services such as vision, dental and hearing care. The costs and items covered will depend on the specific plan you have.
When it comes to managing diabetes, be sure to review how your Medicare coverage may cover what you need. Also, your annual Medicare Wellness Visit is a great time to talk to your doctor and make sure youre up to date with preventive care services that support your diabetes care.
What Other Cgms Or Insulin Pumps Does Medicare Cover
Medicare also covers the Dexcom G5 CGM, which is another continuous glucose monitoring system.
The Dexcom G5 and FreeStyle Libre are different than insulin pumps, which can monitor and administer insulin. Medicare also covers some types of insulin pumps. A person can talk to their doctor about what monitoring approach may be best for them.
- Part A, which offers hospital insurance coverage
- Part B, which provides coverage for medical insurance
- Part C, also known as Medicare Advantage, which offers an alternative to original Medicare
- Part D, which offers prescription drug coverage
Medicare considers designated blood glucose monitoring systems, such as FreeStyle Libre, to be durable medical equipment . Therefore, Medicare Part B will help pay for a portion of the costs.
However, some qualifying requirements apply, including:
- A doctor must certify that the monitor is medically necessary and prescribe it.
- Both the prescribing physician and the supplier must accept Medicare assignment.
- A person must test their blood sugar levels at least four times a day and use insulin injections at least three times daily.
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Medicare Covers Most Diabetic Testing Supplies As Durable Medical Equipment Or Dme
Nearly $300 billion is spent every year on medical costs associated with diabetes. The good news is if you have Original Medicare, some diabetic supplies are covered by Medicare Part B , including blood sugar testing strips, blood sugar monitors, lancet devices and lancets, and other durable medical equipment .
If youre living with diabetes or are pre-diabetic, its important to understand Medicare coverage for diabetic supplies, especially what is and isnt covered and at what cost, to help ensure you get what you need to stay healthy.
Medicare Eligibility For A Therapeutic Cgm
A therapeutic CGM is a medical device approved by the U.S. Food and Drug Administration as a replacement for home blood sugar monitors. It provides you and your doctor with the medically necessary information to make diabetes treatment decisions, such as changes in diet and your insulin dosage.
To qualify for a therapeutic CGM, you must be undergoing treatment for diabetes and meet certain other criteria.
To be eligible for a therapeutic CGM under Medicare, you must meet the following requirements.
- You are using insulin to treat Type 1 or Type 2 diabetes.
- You need to check your blood sugar four or more times per day.
- You must use an insulin pump or receive three or more insulin injections per day.
- You must make routine, in-person visits to your doctor.
- Your doctor has determined that you meet all Medicare eligibility requirements.
The decision between a therapeutic CGM or a traditional monitor is one you should make after talking to your doctor. A therapeutic CGM may be a better option if you use insulin and frequently change your dosage.
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Medicare Part D Coverage
Part D refers to the prescription drug coverage portion of Medicare and each plan has its own set of covered drugs. Additionally, each drug is placed in a designated tier within that plan, which ultimately determines the copayment and/or coinsurance cost of the drug.
To find out the specific medications your plan covers, check with your Medicare provider or read through your individual plan.
Alternatively, if youre taking a particular drug and want to find a Medicare plan offering the best benefits possible for that specific medication, Medicare.gov has a Medicare Plan Finder on its website that helps you locate options to consider.
Part D refers to the prescription drug coverage portion of Medicare and each plan has its own set of covered drugs.
Does Medicare Cover Diabetes
In addition to the diabetes services and supplies covered by Medicare Part B , others are covered by Part D .
Typically, Medicare Part B covers the services that may be needed by people who have diabetes, as well as preventive services for people who may be at risk or are pre-diabetic, including:
- Diabetes screenings
- Medical Nutrition Therapy services
- Foot exams and treatment
- Welcome to Medicare preventive visit
- Annual wellness visit
- Insulin pumps
- Therapeutic shoes or inserts
Medicare Part D covers a number of medical supplies you may need to help treat or control your diabetes. Coinsurance or copayments may apply to these supplies, as well as a Part D deductible. Covered supplies may include:
- Diabetes supplies such as syringes, needles, alcohol swabs, gauze, and inhaled insulin devices
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$0 Copays On Preferred Brand Diabetic Test Strips And Glucose Meters For Medicare Advantage Members
In 2018, Independence will continue the requirement for Medicare Advantage members to use diabetic test strips and a glucose meter from the preferred manufacturer brands, Accu-ChekÂ® and OneTouchÂ®, in order to have their test strips and glucose meters covered at $0 copayment. All other manufacturersâ brand of test strips and glucose meters will not be covered by Keystone 65 HMO plans. For Personal Choice 65SM PPO plans, an out-of-network coinsurance will apply to all other manufacturersâ brand of test strips and glucose meters. If their current glucose meter does not work with either of the preferred brands of test strips, Medicare Advantage members can obtain a new glucose meter at no cost. Test strips can be purchased from either a network pharmacy or durable medical equipment supplier. The $0 copayment on Accu-Chek and OneTouch test strips will apply at both preferred and standard pharmacies. Providers may appeal if they feel a member is unable to use Accu-Chek or OneTouch test strips and glucose meters. Note: Independence Medicare Advantage plans will continue to offer a $0 copayment on all brands of lancets and solutions.Continue reading > >
What Health Plans Does Medicare Offer
Medicare has four parts:
- Part A, or hospital insurance, covers hospital stays, skilled nursing homes, hospice care, and some home health care. Part A has no premium for those who have paid enough Medicare taxes. Part A has a deductible, which is an amount you pay for your care each year before the plan begins to pay.
- Part B, or medical insurance, covers doctor visits, outpatient care, some home health care, medical equipment including insulin pumps, and some preventive services. You pay a monthly premium based on your income. After you pay the deductible each year, Part B pays 80 percent for most covered services, and you pay 20 percent.
- Part B covers the Medicare Diabetes Prevention Program for members with prediabetes. The MDPP provides healthy eating and physical activity training sessions and support over 12 months, which research shows can sharply lower diabetes risk.
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Medicare Now Covers Continuous Glucose Monitors
Medicare now covers Continuous Glucose Monitoring Devices such as Abbotts Freestyle Libre® and the Dexcom G6®. These products have revolutionized the way in which our Medicare patients, who test four times per day or more using blood glucose testers and insulin administering, manage their diabetes.
Medicare Covered CGMs
Continuous Glucose Monitoring coverage for Medicare beneficiaries is easy to establish. If you are a Medicare beneficiary, your doctor has prescribed you to test your blood sugar at least four times per day, you are injecting insulin and you are following your prescribers orders you likely qualify for a Continuous Glucose Monitor. We will work with you and your prescriber throughout the process to gather Medicares required documentation. We ensure that you are adequately trained on your new system, and once you initiate your new and revolutionary CGM, you will experience zero interruptions in therapy.
The Abbott Freestyle Libre® is a system that our Medicare beneficiaries prefer as it is easy to adapt to when transitioning from a glucometer to Continuous Glucose Monitoring. The Freestyle Libre for Medicare beneficiaries is a two component system, with a 14 day sensor and with compliant documentation is available for order on a 90 day supply.
Our team is ready to patiently review all of the details regarding these systems and your coverage. Please call and we will gladly answer any questions you have about CGMs and Medicare coverage requirements.
How Much Will You Pay For Diabetes Supplies Through Medicare Part B
After you have met the Part B deductible, you’ll 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 won’t 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 doesn’t 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. Medicare’s coverage of diabetes supplies and services. Available at: . Accessed August 17, 2018.
2Medicare. Medicare’s 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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Does Medicare Cover Diabetic Supplies
Did you know Medicare beneficiaries are eligible to receive coverage for diabetic supplies they use every day? Medicare can cover a range of prediabetic and diabetic supplies and services, including diabetic shoes and individual health coaching through the Medicare Diabetes Prevention Program. Read on to see what diabetic supplies are covered by specific Medicare Parts and how the Medicare Diabetes Prevention Program works.
What Does Medicare Cover For Diabetics
If you have diabetes, you know its a day-to-day reality that needs to be attended to. It can feel like a full-time job, but you dont have to do it alone.
Medicare covers various diabetes medications, supplies and services to help treat diabetes and keep your blood glucose in a healthy range.
- Medicare Part B covers blood glucose testing and other supplies you may need plus some medical and education services.
- Medicare Part D covers diabetes medications and supplies for injecting or inhaling insulin.
Heres a rundown of the diabetes supplies and services that Medicare covers. Some require a prescription or recommendation from your doctor. Coverage limits may include the amount of some supplies you can get or how often some services are covered.
Diabetes Services Covered By Medicare
Medicare covers a wide selection of services aimed at preventing and managing diabetes. Medicare Advantage plans are required to cover everything that Part B covers, but may offer more services.
These begin with your Welcome to Medicare preventive visit covered by Medicare Part B. The visit is a one-time review of your health that also provides education and services for all Medicare coverage.
You must schedule the visit in your first 12 months after enrolling in Medicare.
Its a good opportunity to talk with your doctor about the conditions you have and what services you need now that you have Medicare coverage.
Beyond that, Medicare also covers yearly wellness visits. These review and update your health prevention plans since your last visit. It will review your medical and family history, a list of your current doctors and prescription drugs and look at your risk factors.
Medicare also covers other services to prevent and treat diabetes.
Diabetes Services Medicare Covers