If you are new to Medicare you may be surprised to learn that not all diabetic supplies are covered by Medicare. Knowing which supplies are covered and where to get them will allow you to maximize your benefits and relieve any strain on your budget.
You may also have questions about how different Medicare plans address diabetic supplies. For instance, is it better to be enrolled in a Medicare Advantage plan or insured through a Medicare supplement?
Other questions concern what is covered by original Medicare and what falls under the auspicious of Part D. This article will answer some of these questions and help you understand how different plans handle the costs for diabetic supplies.
Diabetic supplies covered by original Medicare
When reviewing what’s covered and what’s not covered, it’s best to remember that Medicare was originally enacted to be a safety net and not a comprehensive solution to all health care costs.
Covered Expenses include:
- Blood glucose monitor
- Blood glucose test strips
- Lancet devices (pens, etc.) and lancets
- Glucose control solutions for checking monitor accuracy
- Therapeutic shoes or insoles
Keep in mind that there may be limits on the quantity of testing supplies you can receive in any given time frame. Also, you cannot submit claims for supplies yourself. All claims must be submitted by Medicare-enrolled pharmacies and suppliers. In addition, you must request refills on your supplies, as automatic shipments from suppliers will not be covered by Medicare.
Diabetic shoes and insoles must be prescribed by a podiatrist and supplied by a Medicare authorized provider. The supplier must have a Medicare supplier number in order to have expenses covered. If a supplier does not have a Medicare supplier number, even if the company is well known or a large department store, the costs will not be covered by Medicare.
You are able to get one pair of shoes or insoles once a year and shoe modifications may be substituted in lieu of new shoes or insoles. The cost of fitting new shoes is also covered.
As mentioned above, Medicare is not going to offer comprehensive benefits. As such, you will be responsible for 20% of the approved expense for the supplies listed above.
Non-Covered Expenses include:
- Insulin (unless used with an insulin pump)
- Insulin pens
- Alcohol swabs, pads or bandages
Diabetic supplies covered by Part D
Many diabetics rely on Medicare Part D to help pay for their medications. While original Medicare doesn’t cover insulin and related supplies, a Part D plan will. But not all plans are created equal and you must compare plans to find the best benefits for your circumstances.
When comparing plans related to covering your diabetic medications, take the following features into account:
- The Part D formulary (list of covered drugs)
- Tier placement of medications related to competing plans
- Copays, coinsurance and any required deductibles
- Pharmacy network
- Mail order benefits
You can receive your Part D benefits in one of two ways; either join a Medicare Advantage plan
which includes drug benefits (MAPD) or join a stand-alone Part D plan. Many Medicare Advantage plans may also include some ancillary benefits that diabetics may find useful.
If you are receiving your health benefits from original Medicare or through Medicare and a Medicare supplement policy, you should enroll in a stand-alone Part D plan. Most often a Medicare supplement policy (Medigap) will pay the 20% of expenses that you would normally be responsible for.
When comparing the benefits of an Advantage plan versus original Medicare and a supplemental policy, be sure to consider the network restrictions as well as the difference in associated premiums and costs for using your plan.
No matter how you choose to receive your Medicare benefits, know which diabetic supplies are covered and how to receive them can help you get the most out of your Medicare benefits.