Supplies And Services Covered By Medicare Parts B And D
Many diabetic supplies are a covered benefit of Medicare Part B. If you are enrolled, or eligible to enroll, in original Medicare, youll receive coverage for diabetic supplies and services.
Medicare pays the majority of the cost, but you are still responsible for 20 percent. You will also pay for any coinsurance, deductible, and copayment costs.
You can buy a supplemental plan to help offset some of these costs, such as a Medigap plan. Review different plan options to find one that best meets your needs.
For Medicare to cover diabetic supplies, your doctor needs to write prescriptions that explain:
- you have received a diagnosis of diabetes
- any special devices/monitors you need and why
- for special shoes, a podiatrist or other foot specialist has to explain why you need special shoes and provide a prescription
- how often you need to test your blood sugar levels
- number of test strips and lancets you need
New prescriptions are needed each year from your doctor. If you need to monitor your blood sugar more often, your supply limits for each month will need to be increased.
Read Also: Is Insulin Used To Treat Type 2 Diabetes
What If I Need A Specific Item Or Supply
If you need a specific item or brand of supply, or a specific form, your doctor must prescribe the specific brand or form in writing. Your doctor must also document in your medical record that you need this specific supply for medical reasons. In these situations, a Medicare contract supplier is required to:
Give you the exact brand or form of item you need
Help you find another contract supplier that offers that brand or form
Consult with your doctor to find an alternative brand or form, and get a revised written prescription from your doctor
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.
You May Like: Are Brussel Sprouts Good For Diabetics
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.
When It Comes To Diabetes What Does Medicare Cover
There are many programs within Medicare that can help offset the costs of diabetes treatment.
The Centers for Medicare & Medicaid Services reports that Medicare Part B will generally cover equipment and supplies like home blood sugar monitors and tools for measuring blood sugar, including:
- Test strips
- Glucose control solutions
Medicare Part B will also cover external insulin pumps and the insulin required for the pump, if you meet certain conditions.
The U.S. Department of Health and Human Services reports that those using Original Medicare can also have diabetes supplies delivered through the National Mail-Order Program. With this program, youâll select a national mail-order contract supplier for Medicare in your zip code using the official U.S. government website for Medicare. This supplier will help you get quality supplies at a discount.
Additionally, if you have diabetes and severe diabetic foot disease, Medicare Part B includes some specialized shoe coverage. One pair of custom shoes plus their inserts and one pair of extra-depth shoes are covered once a year under Medicare Part B, according to the official U.S. government website for Medicare.
Medicare Part D
Medicare Part D helps cover the cost of prescription drugs through private insurance companies. The Centers for Medicare & Medicaid Services notes that Medicare Part D covers the following:
Part D also covers diabetic supplies like:
- Insulin inhalers
Don’t Miss: What Do You Do If You Think You Have Diabetes
Get Important News & Updates
Sign up for email and/or text notices of Medicaid and other FSSA news, reminders, and other important information. When registering your email, check the category on the drop-down list to receive notices of Medicaid updates check other areas of interest on the drop-down list to receive notices for other types of FSSA updates.
How To Learn More
- For more information on all of the options available under Medicare, visit: www.medicare.gov or call 1-800-MEDICARE . Also look for the Medicare and You handbook which Medicare mails to beneficiaries in the fall and is available by calling 1-800-MEDICARE .
- To read more about Medicare coverage of diabetes services and supplies, go to .
- For information from Medicare on how individuals might be able to get help paying Medicare costs visit www.medicare.gov/your-medicare-costs/help-paying-costs/get-help-paying-costs.html or call 1-800-MEDICARE .
- Free health insurance counseling and personalized assistance for Medicare beneficiaries is available in every state through the State Health Insurance Assistance Program . Call 1-800-MEDICARE or visit www.shiptacenter.org to find the telephone number of the SHIP office closest to you.
Don’t Miss: How Can I Check If I Have Diabetes
Blood Glucose Test Strips And Lancets May Qualify For Coverage And Payment Under Medicare Part B
Under §§ 1832, 1861, and 1861 of the Social Security Act, home blood glucose test strips and lancets prescribed by a qualified physician to treat a diabetes patient may qualify for coverage and payment under Medicare Part B as long as the supplies are medically necessary and meet certain requirements specified by the CMS and DME MACs working on the CMSs behalf. These coverage and documentation requirements are intended to help ensure that test strips and lancets ordered for use by a Medicare beneficiary are, in fact, medically necessary. Unfortunately, many physicians and suppliers are either unaware of these detailed requirements or do not recognize the importance of properly maintaining supporting documentation.
What Supplies Do People With Diabetes Need
Anyone with diabetes should have an individualized care plan because there are different types of diabetes and no two people are exactly alike when treating the disease. Many different variables dictate needs, such as: what type of diabetes you have, how long youve had diabetes, if you have complications of diabetes, how many times per day you test your blood sugar, what type of medication you are on, and more.
For example, if you have type 1 diabetes and take multiple daily injections using an insulin pen device, you will need pen needles, insulin, replacement pens or replacement insulin cartridges, a blood glucose meter, lancets, alcohol swabs, test strips, ketone strips, glucose tablets, glucagon, etc. If you have type 1 or type 2 diabetes and use insulin pump therapy with a continuous glucose monitor, you will need all the above supplies, in addition to infusion sets, sensors, insulin for your pump, tubing, etc.
Pump users are encouraged to have backup insulin at home in case there is a pump malfunction. If you are a person with type 2 diabetes and take oral glucose medication and have a history of peripheral neuropathy , you may need oral medication, a blood glucose meter, test strips, alcohol swabs, compression stockings, and diabetes shoes. Your diabetes care team will help you to understand what types of supplies you need and how long they will last before you need them to be refilled.
You May Like: How Much Does It Cost To Make Insulin
Mail Order Diabetic Supplies
In this digital era, the World Wide Web is being widely used by numerous people across the globe to work or even to buy items including groceries, and have them delivered to their preferred destination. Therefore, it also makes perfect sense to purchase all your diabetic supplies online and have them delivered to your preferred destination.
Therapeutic Shoes And Inserts
Medicare Part B may also cover therapeutic shoes or inserts if you need them for your diabetes, but you have to meet certain conditions. You may qualify for one pair of depth-inlay shoes and three pairs of inserts per year.
If you cant wear depth-inlay shoes, Medicare may pay for one pair of custom-molded shoes and two pairs of inserts.
You have to meet certain conditions, including being diagnosed with diabetes, are in a comprehensive treatment plan and require the shoes and inserts.
You also must have at least one of these conditions:
- Diabetes-related nerve damage with signs of callus problems
- Foot deformity
- Partial or complete foot amputation
- Poor circulation
You will also need a podiatrist or other qualified health care professional to prescribe the shoes and to fit and provide them.
Read Also: What Is The Most Common Form Of Diabetes
Whats The National Mail
Medicares National Mail-Order Program for diabetes testing supplies helpsyou get quality supplies and save money. If you want diabetes testing supplies delivered to your home, youll need to use a national mail-order supplier that has a contract with Medicare. If you dont want diabetes testing supplies delivered to your home, you can get them from any local store thats enrolled with Medicare.
The National Mail-Order Program includes all parts of the U. S., including the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, and American Samoa.
The Best Diabetic Supply Companies Of 2022
- Best for Medicare and Medicaid Insurance: Edgepark
- Best Support for Medtronic Users: Medtronic
- Best for Specialized Insulin Pump & Technology: Tandem
- Best for Pediatric Population: Insulet
- Best for Replacements: Dexcom
Will review all your insurance options to help save money
May not be available to all types of Medicare plans
Pump users may be locked into warranties
Why we chose it: Many health professionals and people living with diabetes recommended Byram Healthcare to us for diabetes supplies. Its deliveries are very reliable and because it offers so many products, it may serve as a one-stop-shop for diabetes supplies. Priding itself on convenience, affordability, and choice, Byram Healthcare offers a comprehensive product line of diabetes supplies ranging from diabetes test strips, lancing devices, lancets, control solution, batteries, blood glucose meters, insulin pump supplies, continuous glucose monitor supplies, insulin and pen needles, and more.
You May Like: Cauliflower Pizza Crust For Diabetics
A Wider Range Of Supplies
Another added advantage is that online suppliers avail a wider range of product variety than stocks available in most physical pharmacies. Moreover, it is always easier to search for a particular product online than having to visit different stores when you cant find what you are looking for in one shop.
How Can I Help Medicare Fight Fraud
When you get health care items or services, save your receipts and statements to check for mistakes. Compare this information with your claims to make sure you or Medicare werent billed for items or services you didnt get. The sooner you see and report errors, the sooner we can stop fraud.
Medicare has several easy ways for you to review your claims:
If you suspect fraud, call 1-800-MEDICARE. You can also visit oig.hhs.gov, or call the fraud hotline of the Department of Health and Human Services Office of Inspector General at 1-800-HHS-TIPS .
To learn more about how to protect yourself from health care fraud, visit Medicare.gov or contact your local Senior Medicare Patrol . To find the SMP in your state, go to the SMP Locator at smpresource.org.
Don’t Miss: Surgical Treatment For Type 2 Diabetes
How Does Medicare Cover Diabetes
Different parts of Medicare cover different services and supplies. That said, some things arent covered by Medicare, and in many cases, you will pay a portion of the cost, unless you have another insurance plan that covers it.
Medicare coverage for diabetes would usually be obtained by enrolling in Original Medicare or a Medicare Advantage plan .2
Is There Medicare Coverage Of Diabetes Prescription Drugs Medical Supplies And Insulin
If you receive your Medicare benefits through Original Medicare, there is limited coverage for prescription drugs under Medicare Part B. Insulin is typically not covered except in very narrow circumstances, such as the insulin used in external insulin pumps .
If you would like help with insulin and prescription drug costs, you will need to enroll in a Medicare plan with prescription drug coverageeither a stand-alone Medicare Part D Prescription Drug Plan if you remain with Original Medicare, or a Medicare Advantage Prescription Drug plan. Keep in mind that every Medicare plan with prescription drug coverage uses a formulary, which is a list of approved medications that are covered under the plan. To avoid high out-of-pocket costs, be sure to ask your doctor if the medication he or she is prescribing is included in your prescription drug plans formulary. Also, please note that the formulary may change at any time and that the plan will notify you when necessary.
Medicare Advantage offers an alternative way to get your Original Medicare benefits. Medicare Advantage plans, which must offer all the same benefits as Original Medicare at a minimum , may also help you manage your out-of-pocket costs. Thats because most of them include coverage for prescription drugs, and may include additional benefits like routine vision, hearing, and dental care. You still continue paying your Medicare Part B premium, as well as any premium the Medicare Advantage plan may charge.
Also Check: Does One High A1c Mean Diabetes
What Can Diabetes Educators Do To Help Pwd
- Take a moment to explain the National Mail Order Program and how it works: PWD are to receive the DTS prescribed to them via mail order.
- Walk the individual through the CMS website, as it can be overwhelming to navigate.
- When a person requires a particular brand for a medically significant reason , document the rationale in the medical record, and have the prescription written with NO SUBSTITUTIONS or the box checked Do not substitute on the prescription form. The supplier must provide the prescribed brand, help find another supplier who offers the brand, or work with you to find an alternate brand with a revised written prescription.
If the prescribed brand is not in stock with a mail order supplier, the person should not be required to change brands. If the person is sent incorrect supplies, instruct him/her to call 1-800-MEDICARE or the Fraud Hotline of the HHS Office of Inspector General at 1-800-HHS-TIPS.
Learn more about the National Mail Order Program.
What Diabetes Supplies And Equipment Does Medicare Cover
Medicare Part B coverage of diabetes includes certain blood sugar self-testing equipment and supplies such as:
- Blood sugar testing monitors
- Glucose control solution for calibrating monitors
- Therapeutic shoes or inserts
Diabetes equipment and supplies that are used at home are considered durable medical equipment for the purposes of Medicare coverage and subject to certain restrictions. In order to get payment for these products, both your doctor and the company must be Medicare-approved. You are generally responsible for 20% of any allowable charges plus any of the unpaid Part B deductible amount. Medicare Part B may also pay for external insulin pumps and the insulin the devices need if your doctor believes it is medically necessary to treat your condition.
Recently, Medicare implemented the Competitive Bidding Program, which works with specially contracted equipment suppliers to help lower health-care costs. If you live in a part of the country where the Competitive Bidding Program is in force, you must use a supplier who is contracted with Medicare to provide the equipment.
Don’t Miss: Does Water And Baking Soda Help Diabetes
Why All American Medical
All American Medical is an established Medicare approved provider of Diabetic Testing Supplies and Durable Medical Equipment. As a company, we are committed to helping you manage your healthcare needs and strive to provide only the highest standard in healthcare technology. We have been awarded exemplary provider accreditation status by ACHC. Obtaining accreditation empowered us to display our continued commitment to excellence in patient care and safety, our products, and customer satisfaction. Over 100,000 customers have trusted All American Medical to provide them with their diabetic supplies.
How Much Will You Pay For Diabetes Supplies Through Medicare Part B
After you have met the Part B deductible, youâll 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 wonât 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 doesnât carry Accu-Chek products, visit your local retailer to fill your Accu-Chek Guide test strip prescription.
Sign up for Accu-Chek news and offers
Get emails sent directly to your inbox with the latest updates and deals on Accu-Chek products.
1Centers for Medicare and Medicaid Services. Medicareâs coverage of diabetes supplies and services. Available at: . Accessed August 17, 2018.
2Medicare. Medicareâs 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.
Recommended Reading: Can Diet And Exercise Cure Type 2 Diabetes
Don’t Miss: How Does Diabetes Affect Your Feet