Getting the most from your health care coverage
Dealing with health care coverage can be frustrating. But the more you know about it, the more effective you'll be in getting your diabetes needs met.
Your health plan
Before you start a program or treatment, thoroughly read your health insurance policy to make sure you're covered.
Don't be shy about calling your health plan's customer service line if you have trouble figuring out exactly what your policy says. Many people have trouble understanding the wording in the health plan literature.
If your plan denies coverage, don't give up. When your plan tells you that something isn't covered, call and find out why. Find out what can be done to reverse the decision. Maybe you need to send them additional documentation. Maybe you need a letter from your doctor. Maybe they made an error.
Medicare
Medicare is the federal health insurance program for people age 65 and older. It also covers people with disabilities who are under age 65, as well as people with end-stage kidney disease who need dialysis or a kidney transplant.
To keep costs down, be sure to use a health care provider who accepts Medicare. Call 1-800-633-4227 to ask for a list of "participating providers" or "doctors who accept Medicare assignment."
Coverage for diabetes supplies and services commonly comes through Medicare Part B. Generally, Medicare covers 80 percent of the cost of these supplies and services after you meet the annual $135 deductible:
- glucose monitors, blood glucose test strips, lancets and lancet devices, glucose control solutions
- therapeutic shoes for diabetes-related foot disease
- foot care once every six months if you have peripheral neuropathy
- glaucoma screening once a year
- insulin when used with a pump
Medicare Part B also covers diabetes self-management training and medical nutritional therapy:
- Diabetes self-management training – The first year after being diagnosed with diabetes, you can have 10 hours of training with diabetes educators and other qualified professionals. Every year after, you can receive two hours of follow-up education.
- Medical nutritional therapy – If your doctor says you need help with your meal planning, you can receive three hours of medical nutritional therapy the first year after diabetes diagnosis and two hours every year thereafter. The therapy must be from a registered dietitian or other qualified nutrition professional.
Insulin and Medicare coverage
Medicare Part B only pays for insulin that's used with an insulin pump. But Medicare may cover both the insulin and the pump as durable medical equipment. For more details, call a Medicare administrative contractor for durable medical equipment.
If you do not use a pump, your insulin, supplies needed to inject insulin, and other diabetes medicines can be covered by Medicare Part D. For more about the prescription drug benefit program, call 1-800-633-4273 (MEDICARE) or visit www.medicare.gov.
Dialog home page
Allina Medical Clinic: Diabetes education
American Diabetes Association: Medicare
Medicare Interactive: Does Medicare cover diabetes services and supplies?
Source: American Diabetes Association; Diabetes eMagazine, Sept./Oct. 2002; Medicare Interactive; Medicare Rights Center
First published: 09/04/2002
Last updated: 04/24/2008
Reviewed by: Mary Frederick, RN, MS, CDE, diabetes program manager, Allina Medical Clinic
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