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Medicare Coverage

What items will Medicare cover?

Will Medicare cover the cost of my diabetic supplies, even if I don't use insulin?

How much do I pay?

What are the Medicare reimbursement guidelines?

What is Medicare Part D?

What items will Medicare Part D cover?

Who is eligible for Medicare Part D?

Is extra help available for those who need it?

What will Medicare Part D cost me?

Questions?

Private Insurance

Will my private insurance cover the cost of my diabetic supplies, even if I don't use insulin?

What does private insurance mean?


Medicaid Coverage

What is Medicaid?

Why is Medicaid different in every state?

Which state Medicaid programs does Diabetic Care Services participate?

Who is covered by Medicaid?

What items will Medicare cover?

Blood Glucose Meters, Test Strips, Control solutions, Lancets, Lancing Devices and Batteries for your meter and Insulin Pump supplies.

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Will Medicare cover the cost of my diabetic supplies, even if I don't use insulin?

If you have diabetes and are on Medicare, you may be eligible to receive home delivery of diabetic supplies such as a glucose meter, test strips, lancets, lancing devices, and other items to help you control diabetes.

Medicare says that you may save money by getting your diabetic supplies from a provider that accepts the price assigned by Medicare. Diabetic Care Services accepts the price assigned by Medicare, which means we will request direct payment from Medicare and/or private insurance carrier(s).

  • Under assignment, DiabeticCareServices.com agrees to accept the approved charge determined by Medicare and/or insurance carrier(s) as the full charge for the covered service.
  • DiabeticCareServices.com will not collect from the customer, for any item it accepts assignment on, for the covered services more than the applicable deductible and co-insurance, if any.

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How much do I pay?

Medicare will reimburse either 80% of the Medicare-approved amount or 80% of the retail price, whichever is lower. This means that once the annual "Part B" deductible is paid, you pay the other 20%. If you have supplemental or secondary insurance, you may pay nothing at all.

Diabetic Care Services will take care of all the Medicare paperwork and billing submissions for you.

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What are the Medicare reimbursement guidelines?

Product

For insulin treated patients

For non-insulin treated patients

Blood Glucose Monitoring Systems

1 every 5 years

1 every 5 years

Test Strips

100 per month

100 every 3 months

Lancing Device

1 every 6 months

1 every 6 month

Lancets

100 per month

100 every 3 months

Control Solution

1 every month

1 every month

Batteries

1-2 every year

1-2 every year

Important note: If your doctor recommends that you test more often than the guidelines allow for, he or she can authorize you to get more products that are reimbursed by Medicare. The prescription will need to authorize the number of times a day you should be testing, and the reasons why he or she recommends more testing. Diabetic Care Services will contact your doctor and get the prescription for you.

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What is Medicare Part D?

Medicare's new prescription drug coverage -- Medicare Part D, also known as Medicare's new prescription drug coverage program, went into effect January 1, 2006. This program was developed to address the rising cost of prescription drugs by helping Medicare beneficiaries with the cost of their medications.

Most people who are eligible for Medicare will recognize significant savings opportunities by joining a Medicare Part D plan. There are many plans available, and all plans will be administered by private companies. Plans fall into two categories. The prescription drug plan covers only drugs and can be used with your traditional Medicare Part A or B and/or a Medicare supplement plan. The other category for those who currently have Medicare Part C is called a Medicare Advantage Prescription Drug Plan which combines prescription drug coverage with other healthcare services.

Check with your pharmacist for assistance to determine what plans are available in your area.

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What items will Medicare Part D cover?

Most legend drugs, insulin and insulin supplies, such as syringes, needles, gauze, alcohol, swabs, insulin pens and needle-free syringes.  Vaccines, prescription-basked smoking cessation products, injectable drugs and infusion drugs that can be self-administered or administered in the home setting, if they are not already covered under Medicare Part A or B.  Drugs that are not already covered under Part B (or for an indication that might not be covered under Part B), such as infusion drugs that are delivered through a mechanism, such as a drip bag; intramuscular and intravenous drugs, such as antibiotics; pain management drugs; chemotherapy drugs; parenteral nutrition; immunoglobulin; and other infused drugs.

This is not an all inclusive list of drugs covered by Medicare Part D.

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Who is eligible for Medicare Part D?

Generally, people who are 65 years old or older, and others with certain disabilities. Coverage cannot be denied due to health reasons. Everyone with Medicare is eligible for this coverage, regardless of health status, or current prescription expenses.

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Is extra help available for those who need it?

Yes. Premiums may be reduced or eliminated and other payments may be less for people with limited incomes. If you have both Medicare and Medicaid, you already qualify for limited-income assistance. If you don't qualify for Medicaid, you may still qualify for some assistance if your annual income is below $14,355* for an individual, or $19,245* for a couple. For clarification, contact your local Social Security Administration office. *Actual numbers may vary

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What will Medicare Part D cost me?

What will it cost me? The plan itself may have a charge, called a premium. Currently the average premium is $32.00 per month. Under the standard benefit:

  • You will pay the first $250 in drug costs each year. This is called a deductible.
  • After the deductible is met, the plan will pay about 75% of covered prescription drug costs. You will pay the rest (up to 25%, this is called the "co-payment").
  • Should your yearly drug costs exceed $3,600, then the plan pays 95% of covered prescriptions and you pay the additional 5%.
  • The process starts over each year and could be modified.
    It is very important that you choose carefully to find the plan that is best for you and your individual prescription needs. To do this, review each CMS approved Medicare Part 0 drug plan's formulary, which is a government approved list of drugs it covers. Formularies will vary from plan to plan, so talk to your doctor and pharmacist to see which meets your specific needs best. Even if a drug is not covered on your plan, you will still have access to drugs that could save you money.

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    Questions?

    Call us at 1-800-633-7167 to speak to one of our pharmacists or contact us at Pharmacy@diabeticcareservices.com

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    Will my private insurance cover the cost of my diabetic supplies, even if I don't use insulin?

    If you have diabetes and have any private insurance plan(s), you may be eligible to receive home delivery of diabetic supplies such as a glucose meter, test strips, lancets, lancing devices, and other items to help you control diabetes. Diabetic Care Services may save money because we accept the price assigned by most private insurance plans. Diabetic Care Services accepts the price assigned by most private insurance plans, which means you may receive the best pricing available to private insurance beneficiaries. We will help you get the benefits you are entitled to receive.

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    What does private insurance mean?

    Private insurance is any insurance plan that you have obtained through a past or current employer, or an individual policy (not through an employer).

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    What is Medicaid?

    Medicaid is health insurance that helps many people who can't afford medical care pay for some or all of their medical bills. Good health is important to everyone. If you can't afford to pay for medical care right now, Medicaid can make it possible for you to get the care that you need so that you can get healthy and stay healthy.

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    Why is Medicaid different in every state?

    Medicaid is a joint federal-state program. It provides medical assistance to eligible needy persons. Unlike Medicare it is an entitlement program based on income and asset guidelines.

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    Which state Medicaid programs does Diabetic Care Services participate?

    Diabetic Care Services accepts Ohio, Illinois and Pennsylvania Medicaid.

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    Who is covered by Medicaid?

    Medicaid is available only to people with limited income. You must meet certain requirements in order to be eligible for Medicaid. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers.

    In general, you should apply for Medicaid if your income is limited and you match one of the descriptions of the Eligibility Groups. (Even if you are not sure whether you qualify, if you or someone in your family needs health care, you should apply for Medicaid and have a qualified caseworker in your state evaluate your situation.)
    For specific information about enrolling in Medicaid, eligibility, coverage and services for your State, please contact your local Medicaid office.

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