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The Medicare Mystery

David Mendosa

Dec 1, 2004

Understanding the federal government is complex, and the Medicare program can be even worse.

Working with Medicare is one of the biggest challenges for people seeking coverage of diabetes supplies and services.

“People have a hard time with Medicare,” says Tim Cady of Advanced Diabetes Supply (www.northcoastmed.com.), a division of North Coast Medical Supply in San Diego.

Tim should know, because his national mail order diabetes company specializes in helping people who have Medicare insurance get their testing and insulin pump supplies.

Medicare is the nation’s largest health insurance program, covering about 40 million people. You are probably eligible for Medicare if you are disabled, have reached your 65th birthday or have permanent kidney failure treated with dialysis or a transplant.

If Medicare is an enigma that you haven’t unraveled, this column can help.

Once the deductible has been met, Medicare Part B will generally pay 80 percent of the cost of blood glucose testing supplies. Your supplemental insurance, if any, will usually pay most of the balance.

Medicare is difficult to navigate now, but for most of us, it was impossible six years ago. In July 1998, Medicare expanded coverage of blood glucose meters and test strips for all people with diabetes. Earlier, it covered blood glucose monitors and test strips only for people with insulin-dependent diabetes.

Medicare will cover everything you need for testing, whether you use insulin or not. This includes:

the meter itself
test strips
lancets

But Medicare sets some low test-supply limits. If you use insulin, the standard limit is 100 test strips and lancets every month. If you don’t use insulin, the standard limit is 100 test strips and lancets every three months.

The government seems to think that we test for the fun of it. Three tests a day when you use insulin and just once a day if you don’t is far fewer tests than many of us need.

Well-written prescriptions, however, can get you what you need. They should not say, “test once or twice a day,” because Medicare would understand that to mean once a day.

When you need to test more often than Medicare’s limits, the prescription also has to give specific reasons. These can include fluctuating blood glucose, uncontrolled blood glucose, hypoglycemia, hyperglycemia or an adjustment in your medication.

Q: Where can I find the government’s own regulations to argue my case?

A: The Internet has two excellent resources:

The Official U.S. Government Site for People With Medicare at medicare.gov. Search for “Medicare Coverage of Diabetes Supplies and Services.”
Medicare’s detailed regulations are available on the Web sites of each of Medicare’s four Durable Medical Equipment Regional Carriers (DMERCs). Each of these DMERCs have the same regulations, and the easiest to find and use is that of Palmetto Government Benefits Administrators at http://palmettogba.com. Search for “Chapter 38—Home Blood Glucose Monitors.” It is the first link returned.

Categories: Blood Glucose, Diabetes, Diabetes, Health Insurance, Insulin, Insulin Pumps, Low Blood Sugar, Meters

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Dec 1, 2004

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