Medicare benefits, insurance coverage and reimbursement can be very confusing. The good news is that our diabetes care products are covered by Medicare.
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If you are receiving Medicare Part B benefits, Medicare will cover your diabetes self-monitoring testing supplies prescribed by your doctor. You can be reimbursed for most of your costs. This applies to you whether or not you use insulin. diabetes self-monitoring testing supplies are covered by Medicare:
MICROLET®2 Adjustable Lancing Device
MICROLET® Lancets (100s)
MICROLET® Colored Lancets (100s)
Medicare will reimburse either 80% of the Medicare Fee Schedule or the actual charges whichever is less. This means that once the annual Medicare “Part B” deductible is paid, you pay the other 20%. If you have supplemental or secondary insurance, you may pay even less than the 20%. Many pharmacies, mail order and medical equipment suppliers will take care of all the Medicare paperwork and billing submissions for you. Ask if this service is offered before you buy your diabetes self-monitoring testing supplies.
|Product||For insulin treated patients||For non-insulin treated patients|
|Blood Glucose Monitoring Systems: CONTOUR®NEXT, CONTOUR®NEXT EZ, CONTOUR®NEXT USB, CONTOUR®NEXT LINK, CONTOUR®LINK, BREEZE®2, CONTOUR®, CONTOUR®USB, CONTOUR® TS||1 every 5 years||1 every 5 years|
|Diabetes Test Strips||100 per month||100 every 3 months|
|MICROLET®2 Adjustable Lancing Device||1 every 6 months||1 every 6 months|
|MICROLET® Lancets & Colored Lancets||100 per month||100 every 3 months|
Important note: A doctor’s prescription is required for Medicare reimbursement. If your doctor recommends that you test more often than Medicare’s guidelines permit, your doctor can authorize you to receive more self-testing supplies which Medicare will cover after additional requirements are met. For more information, check with your doctor.
Congress passed a law requiring Medicare to implement a Competitive Bidding Program for certain durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). The program changes the amount Medicare pays suppliers for DMEPOS supplies and changes who can provide these items to Medicare beneficiaries.
Under this program, suppliers submit bids to furnish certain DMEPOS products to Medicare beneficiaries. Based upon the bids, Medicare determines the amount it will pay for the supplies and selects the suppliers who can provide the products.
Has the Competitive Bidding Program started?
The competitive bidding program started on July 1, 2013. Reimbursement amounts for suppliers changed at this time to the amounts achieved through the bidding program. If you currently receive your products from a mail order supplier, and your current mail order supplier was not selected as a “winner” by Medicare, you may need to find a new Medicare “contracted” mail order supplier or you may purchase your products at a local pharmacy.
Are diabetes testing self-supplies included in the program?
Yes, but only for diabetes self-monitoring testing supplies delivered through the mail. This program does not affect diabetes testing supplies purchased at retail pharmacies.
Are diabetes self-monitoring testing supplies still covered by Medicare?
Yes. Medicare Coverage Guidelines for diabetes self-monitoring testing supplies are not affected by the Medicare Competitive Bidding Program, so patients may continue using their meter systems and related supplies.
How do I know if I am affected by this program?
If you choose to receive your supplies through the mail you are affected by this program. You can find the Medicare contract mail order supplier list at: www.medicare.gov.
Where can I get my diabetes self-monitoring testing supplies if I am affected by this program?
You can get your diabetes self-monitoring testing supplies at your local retail pharmacy or through a Medicare contract mail order supplier, if you choose to receive your supplies through the mail. For a list of Medicare contract mail order suppliers, please visit: www.medicare.gov.
If my doctor writes a prescription for diabetes self-monitoring testing supplies, but I can’t get it through the Medicare mail order contract supplier in the Competitive Bidding Areas, what should I do?
You may obtain your diabetes self-monitoring testing supplies at your local retail pharmacy.
According to the Facts about the DMEPOS Competitive Bidding Program, “If a physician or treating practitioner prescribes a particular brand or mode of delivery for a beneficiary to avoid an adverse medical outcome, the contract supplier must, as a term of its contract, ensure that the beneficiary receives the needed item. The contract supplier has three possible options. First, the contract supplier could furnish the specific brand or mode of delivery as prescribed. Second, the contract supplier could consult with the physician or treating practitioner to find another appropriate brand of item or mode of delivery for the beneficiary and obtain a revised prescription. Finally, the contract supplier could assist the beneficiary in locating a contract supplier that will furnish the particular brand of item or mode of delivery prescribed by the physician or treating practitioner. If the contract supplier does not ordinarily furnish the specific brand or mode of delivery and cannot obtain a revised prescription or locate another contract supplier that will furnish the needed item, the contract supplier MUST furnish the item as prescribed.” Click Here for Details
More questions about Medicare’s Competitive Bidding Program?
Contact Medicare: www.medicare.gov or www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSCompetitiveBid or you may call 1-800-MEDICARE.
For further information, contact the American Diabetes Association at 1-800-DIABETES.
You can find diabetes self-monitoring testing supplies at your local pharmacy, hospital or clinic pharmacy, or Medicare mail order contract supplier.
Your doctor must give you a prescription in order to obtain Medicare reimbursement. Remember to ask your doctor to specify “Do Not Substitute” on the prescription to ensure that you receive genuine, quality diabetes self-monitoring testing supplies. Then, you can take your prescription to your local pharmacy, hospital or clinic pharmacy, medical equipment supplier, or Medicare mail order contract supplier. You may want to call your chosen supplier to ensure that they sell diabetes self-monitoring testing supplies and that they will assist you in filing your claim.
Diabetes Care diabetes testing supplies are covered by Medicare, and continues to be committed to providing you state of the art diabetes monitoring supplies that are highly accurate and easy to use, so that you can manage your diabetes with confidence.
Because of the reduction of reimbursement, you may be asked by your current Medicare supplier (Mail Order distributor or retail pharmacy) to switch to another brand of test strips. Since Medicare covers all diabetes testing supplies, you can insist on continuing with your current testing supplies. If you have any difficulty in obtaining your testing supplies, please call us (1-800-348-8100) and we will help you find a Medicare supplier who will provide you with testing supplies.