What diabetes benefits are available to someone if they are medicare eligible?
All American citizens over age 65, the disabled, and individuals with end-stage renal disease who purchase Medicare Part B coverage and/or Medicare managed care policies are eligible for the following:
- Blood glucose testing supplies
- Blood glucose monitors
- Blood glucose test strips
- Spring loaded lancet devices
- Glucose control solution for calibrating meters
However, some limitations apply, including:
- All patients with diabetes are entitled, upon receipt of a physician’s prescription, to a blood glucose monitor for the life of the monitor.
- Patients treated with insulin are eligible for 100 blood glucose test strips and 100 lancets per month.
- Patients not treated with insulin are eligible for up to 100 test strips and 100 lancets every 3 months.
- Physicians may prescribe more test strips, but they must document their patients’ need for additional testing supplies in writing. A physician must renew documentation of this need every six months.
In order to receive coverage for blood glucose test strips and related supplies, a prescription must be written by a physician. This prescription must meet the following guidelines:
- The prescription must be renewed every six months.
- The prescription must clearly document the number of strips and lancets to dispense.
- The prescription must document whether or not the patient uses insulin to manage diabetes.
- The frequency with which the patient should monitor their blood glucose level or use the supplies must be clearly identified. NOTE: This point is extremely important as Medicare will not accept prescriptions that state monitoring should occur or supplies should be used “as needed.”
Insulin Pumps and Supplies for Use with a Pump
Medicare now covers insulin pumps, single and multiple use medical supplies for use with a pump, and insulin for insulin pump users. Medicare restricts coverage for insulin pumps and related supplies to enrollees who use insulin to manage their diabetes. Furthermore, Medicare limits use of pumps to those who have results on a medical test known as a c-peptide test that is within a certain range. Patients must obtain a prescription from their physician for the pump and its supplies and must also go through a diabetes education program in order for Medicare to cover the pump and its related supplies.
Diabetes Education & Medical Nutrition Therapy
Medicare now covers diabetes education services, also known as self-management training and medical nutrition therapy for enrollees with diabetes. Upon the diagnosis of diabetes, or one-time as an enrollee in the Medicare program, a Medicare enrollee is entitled to receive 10 hours of diabetes education. When prescribed by a physician and provided by an appropriately recognized healthcare provider or program, this education will usually occur in a group setting. After this initial training and when prescribed by a physician, a patient can receive up to 2 hours of additional training each year. A physician can also order medical nutrition therapy for a patient with diabetes. A physician can order up to 3 hours of medical nutrition therapy for a patient with diabetes in the first year of diagnosis and 2 hours a year in subsequent years.
Co-pays and Deductibles
Deductibles and co-pays for an enrollee’s Medicare Part B policy will often apply to the described benefits. The deductibles generally require an enrollee to pay for the first $100 of care purchased in a calendar year. After reaching the deductible, a Medicare enrollee is typically required to pay 20% of all charges for items and services while Medicare pays the remaining 80%. Patients with Medigap, other forms of supplemental insurance including Medicaid or those enrolling in a Medicare HMO are generally not responsible for these deductibles and co-pays. Supplemental policies like these typically cover the usual Medicare Part B deductibles and co-pays within the parameters of the supplemental policy’s insurance program.
You can access Medicare or call 1-800-638-6833 for more information about Medicare coverage.