Medicare Coverage for Diabetes Supplies

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As a Medicare patient, you have certain guaranteed rights. You have them whether you are in the Original Medicare Plan, a Medicare Managed Care Plan, or a Medicare Private Fee-for-Service plan. These rights and protections are described in your Medicare & You handbook and include the right to appeal any decision about your Medicare services. For more detailed information about your rights and protections, call 1-800-MEDICARE (1-800-633-4227) to get a free copy of the booklet Your Medicare Rights and Protections.

Medicare: American Diabetes Association®

Medicare Part B covers insulin pumps and pump supplies (including the insulin used in the pump) for beneficiaries with diabetes who meet certain requirements. From January 1, 2014 until December 31, 2016, insulin pumps and pump supplies (but not insulin) are included in the Medicare Competitive Bidding Program in 9 areas of the U.S. This means beneficiaries in these 9 areas with Original Medicare (not Medicare Advantage) generally must use a Medicare contract supplier for Medicare to help pay for these items. Learn more about the program here or by calling 1-800-MEDICARE (800-633-4227).  After December 31, 2016, insulin pumps and pump supplies will no longer be part of the Medicare Competitive Bidding Program which means beneficiaries in these 9 areas can use any Medicare supplier that provides insulin pumps and supplies. It is important to ask if the Medicare supplier “accepts assignment” for insulin pumps and pump supplies. This means the supplier will accept the Medicare-approved amount as payment in full, and you cannot be charged more than 20% coinsurance (after you meet your deductible). If a supplier does not accept Medicare assignment, you may be charged more than the 20% coinsurance. Be sure to check with the supplier to find out what your payment will be. 

Medicare Coverage of Therapeutic Footwear for People with Diabetes

Medicare will pay for 80% of the Medicare-approved amount either directly to the patient or by reimbursement after the Part B deductible is met. The patient is responsible for a minimum of 20% of the total payment amount and possibly more if the dispenser does not accept Medicare assignment and if the dispenser’s usual fee is higher than the payment amount. 

Medicare Coverage Database – Centers for Medicare & Medicaid Services

01/12/2017: CMS has determined that the Medicare Administrative Contractors (MACs) in Jurisdictions 5, 6, 8 and 15 will not be further consolidated. It is anticipated that for these four (4) jurisdictions, their LCDs and Articles details pages will be updated in late April 2017 to reflect their numbered jurisdiction. The display on the document detail pages will be changed from “N/A” to the specific jurisdiction number  in the Jurisdiction Column.  Currently, other MAC jurisdictions have their lettered jurisdiction displayed in this field.

Medicare & Marriage: Spouse Eligibility & Coverage

For Part C (Medicare Advantage), you and your spouse will have your own premium, deductible, and copays. This is true even if you have the same plan. A Medicare Advantage plan is a type of plan offered by a private insurance company to provide you with all your Medicare Part A and Part B services. You may be charged a separate premium by the insurance company and be eligible for additional benefits, including prescription drugs. You may be required to use the plan’s network of health care providers. You can only enroll in a Medicare Advantage when you first become eligible for Medicare (a 7-month period that starts three months before you turn 65, includes the month of your birthday, and ends 3 months after) or during the annual open enrollment period from Oct. 15 to Dec. 7 each year.For Medicare Part D, prescription drug coverage, plans vary and so do the premiums. Even if you and your spouse pick the same plan, you’ll each have to meet the deductible before Medicare starts to pay anything toward your health care. You can only enroll in a Medicare Part D plan when you first become eligible for Medicare or during the annual open enrollment period from Oct. 15 to Dec. 7 each year.

Medicare Part B Overview: Coverage and Premiums

You’ll typically pay a premium for Medicare Part B unless you qualify for financial assistance. Because of this, you have the option of turning it down, although you might pay a late-enrollment penalty if you decide to enroll in Medicare Part B later on. This monthly Part B premium amount may vary from year to year. Remember, you must have both Part A and Part B if you decide to enroll in a Medicare Advantage plan.

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