Medicare Reform Act

Is It a Step in the Right Direction for Diabetes

| Apr 1, 2004

By far, the most important medical legislation passed in 2003 was the Medicare Reform Act

The bill promises:

  • To initiate $400 billion in reforms with a new prescription drug benefit
  • Expanded coverage to low-income seniors and people in rural areas
  • The potential for future competition between Medicare and private insurers

Most of the reforms take effect in 2006, but seniors are scheduled to receive some help via a drug discount card by July 2004.

A One-Time Free Physical

Key among the benefits is a one-time free physical upon enrollment in Medicare, as well as a diabetes screening test—either at the time of the physical or independent of the exam-for those not already diagnosed with diabetes.

Prior Medicare regulations did not cover diagnostic tests unless symptoms were present. By comprehensively screening seniors for high body mass index, high blood pressure and high cholesterol, physicians now have the opportunity to identify those patients most at risk and initiate preventive, preemptive therapy.

In addition, those seniors with diabetes will continue to be eligible for diabetes education, including nutrition counseling (medical nutrition therapy) when provided by an American Diabetes Association Recognized Diabetes Self-Management Program. In addition there are limited benefits for nutrition counseling for certain other conditions such as kidney disease.

Many Benefits for Seniors With Diabetes

Another major provision of the new bill is that seniors with diabetes who use insulin pumps will have insulin reimbursed under Part B of the Medicare program.

Blood glucose monitoring devices and supplies likewise will continue to be reimbursed under Medicare Part B when prescribed by a healthcare provider.

Oral medications, insulin and syringes will be reimbursed under the new Part D guidelines, scheduled to take effect in 2006. The rates of drug coverage under Part D will vary by region of the country.

Prescription drug coverage does not become free in 2006. The standard benefit to take effect calls for a $250 annual deductible coupled with a $35 monthly premium. Seniors would then receive 75 percent coverage of all prescription drug costs up to $2,250 per year. After reaching the $2,250 limit, seniors would be required to pay the full out-of-pocket cost for drugs up to an expenditure of $3,600, at which point coverage would resume.

Seniors with diabetes should be aware that most oral medications will be covered only in generic form. Thus, seniors can dramatically reduce their medication costs by obtaining generic drugs, if available.

Highlights of the New Medicare Legislation

  • New coverage of insulin and syringes for seniors with diabetes who purchase the new prescription drug coverage
  • New coverage of islet cell transplant expenses for seniors and other Medicare enrollees participating in islet cell transplant procedures
  • New coverage for diabetes diagnostic screening tests for people who are at risk for diabetes (such preventive and diagnostic testing were previously prohibited by law)
  • New coverage for a physical exam upon a senior citizen’s entry into the Medicare program

Source: American Diabetes Association Advocacy Team

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Categories: Blood Glucose, Diabetes, Diabetes, Government & Policy, Health Insurance, Insulin, Insulin Pumps, Syringes


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