Do you have carte blanche diabetes Medicare coverage? If your elderly parent has been diagnosed, you know they're going to need some supplies, but who pays?
Understanding what diabetic supply costs are covered by Medicare and what aren't will help you make wiser, more educated decisions regarding your diabetes treatment and management.
If you've been diagnosed with diabetes, you're going to need some basic supplies. Some of the most common include but are not limited to:
Seniors should discuss necessary diabetes supplies with their doctor or pharmacist and make sure they understand what each is used for and why. Many of the supplies used for diabetic care and management are considered Medical Equipment. Medical Equipment and supplies are covered by Medicare Part B coverage. Therefore, diabetic supplies, glucose monitors, and even diabetic shoes for those experiencing foot problems caused by diabetes will enjoy the benefits of Medicare coverage for most of their costs.
In order to qualify for Medicare Part B coverage, the senior's doctor will need to write a prescription for diabetes supplies, such as a glucose monitor, testing strips, and even insulin, syringes, and needles. These diabetes supplies must be documented in regard to their need in medical records and the prescription must be taken to a local pharmacy for filling.
In most cases, suppliers will receive standing orders for such diabetes supplies before they bill Medicare and will keep the prescription on file. However, individuals accessing diabetics supplies through Medicare Advantage plans such as those offered by HMOs or PPOs will have to follow specific advantage plan or provider instructions regarding approval and purchase of diabetic supplies.
Seniors should understand that they may be limited to how often or how many supplies they can receive at one visit to their pharmacy.
The cost of insulin will be covered under Medicare Part D, or prescription medications. Medicare Part B won't cover the cost of insulin unless the senior uses an insulin pump. Medicare prescription drug benefits, (Part D) are utilized for any individual who injects insulin using a needle and syringe. Seniors may also obtain alcohol swabs, gauze, and any other medication that is used to treat diabetes in a home environment as long as such medications are covered and prescribed by the doctor.
Different plans as well as your geographical location will determine how much coverage seniors receive for diabetic supplies. Medicare will pay for supplies that aren't mentioned in a doctor's prescription, so only order supplies that have been approved by the doctor. Seniors should also know that ongoing requests for supplies will be necessary, and shipments that are automatically sent from suppliers won't be paid for. Seniors themselves can't send claims to Medicare. Such claims have to be submitted through a pharmacy enrolled in the Medicare program or an approved supplier enrolled in the Medicare program.
Diabetics supplies are available through medical suppliers and pharmacies. Remember that in order to receive Medicare benefits, the senior must order any supplies or medications through Medicare-participating suppliers.
Individuals enrolled in a Medicare Advantage plan, (such as an HMO or PPO) may need to follow their own process for ordering diabetes supplies, as well as realize that certain plans may have restrictions on the number or location of suppliers. Any HMO or PPO plan is required to offer or supply the minimum of what Medicare covers, and some may even offer more coverage than through Medicare itself.
In addition to insulin pumps and diabetic shoes, equipment and supplies may also include insulin pens and any insulin pump supplies through either Medicare Parts B or D. Insulin pumps are considered a type of Durable Medical Equipment (DME).
According to Medicare for 2010, the individual who only carries Medicare Part B is required to pay 100% for insulin unless it's used with an insulin pump. In this case the senior will then pay 20% of the Medicare approved amount, as well as 100% of syringes and needles if they are not covered by Medicare Part D.