South Central Tennessee Area Agency on Aging & Disability
807 South Main Street, P.O. Box 1346, Columbia, TN 38402-1346
Spring 2009
State Health Insurance Assistance Program
SHIP-SHAPE Q&A
Focus on DIABETES
Question: I have a family history of diabetes. Will Medicare pay for screenings to make sure I don’t get the disease?
Medicare will pay for screenings if you have any of the following risk factors: high blood pressure, high cholesterol and triglycerides, obesity or history of high blood pressure. You may also be eligible for two screenings each year if you answer “yes” to at least two of the following questions:
Although you will be responsible for 20% of the cost of the doctor’s visit, the actual screening itself is not subject to the Part B deductible or 20% copay.
Question:I just learned that I have diabetes. Will Medicare pay for my diabetic supplies and medicines?
Medicare Part B and Part D work together to pay for your diabetic supplies and medications.
Medicare Part B covers supplies such as blood sugar monitors, test strips, lancet devices and lancets. Medicare will pay 80% after you meet the $135 Part B annual deductible. You are responsible for the other 20% of the cost. For many people, this 20% is covered by their retiree insurance or a Medigap policy. If you don’t have some type of insurance to go along with Medicare, you are responsible for the amount that Medicare does not pay.
Medicare Part D covers the cost of insulin as well as any medical supplies associated with the injection of insulin. This includes syringes, needles, alcohol swabs and gauze.
I recommend that you get a copy of “Medicare Coverage of Diabetic Supplies and Services”. This 27-page Medicare publication provides a detailed explanation of how all diabetic-related services are covered. You can order this online at www.medicare.gov or call Medicare toll-free at 1-800-633-4227 to request a free copy.
State Health Insurance Assistance Program
SHIP-SHAPE Q&A
Spring 2009 - continued
Question: I don’t really understand how I should manage my medications, my diet and my exercise to best control my diabetes. How can I learn more about it?
Consider asking your doctor to prescribe “diabetes self-management training”. You are entitled to 10 hours of initial training during the first year and 2 hours every year after that. Health care professionals with special training in diabetes education teach you how to successfully manage your diabetes. You are responsible for the 20% Medicare approved amount of the cost of the training once you satisfy the $135 annual deductible.
Question: I got 100 test strips at my pharmacy and I had to pay full price. Why didn’t Medicare pay for my test strips?
You will need a new prescription each year from your doctor to cover your test strips and lancets. Before you fill this prescription, check to make sure that your pharmacy participates in Medicare. The large chain pharmacies will do the Part B billing for you, but smaller locally owned pharmacies may not be willing to do this. You will be responsible for the full cost of the test strips if your pharmacy does not do Part B billing. Medicare will not allow you to submit these claims yourself.
It is important for you to request refills on your supplies. Medicare will not pay for blood sugar monitors, test strips or lancets that are sent to you automatically.
You should also be aware that there are limits on the amount of supplies that Medicare will cover. Medicare Part B pays for 100 test strips and lancets every month if you use insulin. If you are a diabetic that does not take insulin, Medicare will only pay for 100 test strips and lancets every 3 months. Medicare will cover additional test strips but they need to hear from your doctor that it is medically necessary.
Question: My doctor put me on a new medication called Januvia but my Part D plan says they won’t pay for it. What should I do?
All Part D plans cover diabetic medications, but not all Part D plans cover the same diabetic medications. You should always take a copy of your plan’s list of approved medications (this is called a formulary) to every doctor’s visit. If your doctor determines that you need a new medication, you can share with him the list of medications covered by your plan.
If you have been prescribed a medication that your plan does not cover, you should request an exception from your plan to see if they will pay for it. If they refuse, you will want to take advantage of the Part D Annual Enrollment Period on November 15 to pick a plan that does cover your medication.
State Health Insurance Assistance Program
SHIP-SHAPE Q&A
Spring 2009 - continued
Question: My doctor thinks that I may be better off with an insulin pump rather than daily injections. Who pays for that?
Insulin pumps are considered “durable medical equipment”. That means that Medicare will pay 80% of the Medicare approved amount after you meet your Part B deductible. If you use an external insulin pump, Part B covers the cost of the insulin used with the pump.
Question: Who pays for that blood sugar test that my doctor says I need every three months?
Medicare covers 100% of the cost of the Hemoglobin A1c lab test as long as your doctor orders the test.
Question: My husband says that Medicare doesn’t cover vision. Is that true?
Medicare Part B covers testing for glaucoma every 12 months for people at high risk for glaucoma. If you have diabetes, you are considered high risk. Medicare also recommends that people with diabetes get a “dilated eye exam” each year. You are responsible for paying the $135 deductible and the 20% that Medicare does not cover on these tests.
Question: I have a lot of trouble with my feet. The doctor calls it “peripheral neuropathy.” If Medicare doesn’t pay for routine foot care, do I have to pay for these appointments myself?
Medicare pays for a foot exam every 6 months if you have nerve damage caused by diabetes in either of your feet. Medicare will pay for more visits if your feet have changed in appearance (suggesting a serious foot disease) or if you have had a diabetic-related amputation of the foot.
Medicare also pays for therapeutic shoes or shoe inserts for diabetics with severe foot disease. Once your doctor writes a prescription for them, Medicare Part B will pay 80% of the cost after you meet the $135 annual deductible.
The SHIP-SHAPE column is sponsored by the State Health Insurance Assistance Program (SHIP). This question and answer feature will provide information designed to help Medicare beneficiaries understand and access their Medicare benefits. Please send questions to SHIP Coordinator Jan Graves at jgraves@sctdd.org or 877-801-0044 (toll free).
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