Dealing with MediCare limitations on diabetes test strips, etc
Does anyone have suggestions as to how to prepare for the apparently inevitable problems of getting an adequate number of glucose test strips and other supplies once I turn 65 in a few months. Are there things I should do now? My doctor says Medicare only approves one or two test strips a day. I use 7 to 10, depending on the day, and what activities I'm involved with on that day. I also have the CGM device, which I understand is not covered. I will have supplemental insurance. Has anyone tried appealing these decisions by both Medicare and the supplemental insurance programs, and has anyone had success? I did talk to someone at Dexcom who told me they aren't even trying to get Medicare to approve their device. That is frustrating to me, since I find the Dexcom much more useful to my general control issues and quality of life than any other device, including the insulin pump. I have Type I diabetes.
Tags: Medicare
Replies to This Discussion
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Permalink Reply by jims on
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excuse me a minute. I have Part D in my bag of medicare coverage. It has nothing to do with diabetic test strips as far as I can see. My strips are covered under rebular part B medicare plus my supplement plans. In addition; all strip claims are reviewed by a medicare DME(dureable Medical Equipment ) CMS service center.
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Permalink Reply by Terry on -
You're right and I stand corrected! I'm still five years away from Medicare age and I assumed that the strip coverage was part of the Part D prescription plan. Your comment sent me on an overdue visit to the Medicare web site.
As you said, mail order diabetic supplies are under the Part B durable medical equipment coverage. Who would've thought that our test strips would fall under a "durable" description??!
It's still my understanding that for people who have post-Medicare mail order private coverage will be able to secure strips under that coverage and not be subject to the same scrutiny as the Part B coverage.
I tip my hat.
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Permalink Reply by flynn on -
Medicare supplement only pays for co payments of Medicare. W hat you need to look into is Medicare special needs plan. If you on a employee retirement plan than you need to speak he coordinator. The special need plan for chronic conditions is where I wold go.
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Permalink Reply by sdkate on -
I have medicaid. and medicaid does the same thing, they will only approve payment for 1 - 3 strips a day. I appealed it, but had to get my doc on board with me. They pay or approve whatever the doc prescribes, and so I kept track for two weeks of the number of strips I used per day. What happens when I don't test enough, and when I was testing. I found that if I don't gush with blood, the strip or meter gives me an error reading, it might take me three strips to get a reading. The first time I had a low during that period, I used four strips to get back on track.....the doc realized that it wasn't just one strip, but many that I could be using.
I also went to my county health people begging strips. I asked the doc for samples, I went to our hospital education department and got more. I also (am not proud of this) but ordered meters that stated they come with strips for free. You do what you have to do....and that's the only answer for now, that I have found.
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Today, I found ths summary set of statements about the budget cutting at Medicare and that diabetic strip/testing supplies was being cut over 70 per cent.
I have no way to ascertain the veracity of this but have seen other statements out there saying similar things:
"Medicare reimbursement will be cut by an average of 45% for suppliers participating in Round 2 of the Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program, CMS announced on January 30, 2013. Medicare reimbursement will fall even more dramatically under the national mail order competition for diabetic testing supplies, with payment reduced by 72% compared to current fee schedule amounts (and under the terms of the new “fiscal cliff” law, these prices will be applied in the retail setting as well). Round 2 and national mail-order contracts and prices are scheduled to go into effect on July 1, 2013. CMS estimates that competitive bidding will save the Medicare Part B Trust Fund $25.7 billion and Medicare beneficiaries $17.1 billion between 2013 and 2022.
By way of background, under competitive bidding, only suppliers that are winning bidders, meet licensing and other standards, and enter into a contract with CMS may furnish selected categories of DMEPOS to Medicare beneficiaries in competitive bidding areas (CBAs), with very limited exceptions. Winning bidders who sign contracts are paid based on the median of the winning suppliers’ bids in the CBA, rather than the DMEPOS fee schedule amount. The Round 1 “Rebid” went into effect January 1, 2011 in nine CBAs, involving nine product categories. Payment amounts under the Round 1 rebid average 32% below the Medicare DMEPOS fee schedule amounts. CMS has recently conducted a “recompete” for six product categories in the Round 1 Rebid areas (including additional products) to take effect in 2014.
Round 2 will take place in 100 CBAs covering 91 metropolitan statistical areas, with three-year contracts effective July 1, 2013. CMS announced yesterday that the weighted average savings by product category are as follows:
• Oxygen, Oxygen Equip. & Supplies - 41%
• Standard (power & manual) Wheelchairs, Scooters, & Accessories - 36%
• Enteral Nutrients, Equip. & Supplies - 41%
• CPAP/RAD & Related Supplies & Accessories - 47%
• Hospital Beds & Accessories - 44%
• Walkers & Accessories - 46%
• Support Surfaces (Group 2 Mattresses & Overlays) - 63%
• NPWT Pumps & Related Supplies & Accessories - 41%
CMS also conducted a national mail-order competition for diabetic testing supplies concurrent with the Round 2 competition. CMS announced that Medicare payment for diabetic testing supplies (100 lancets and test strips) under competitive bidding will be reduced from $77.90 to a national rate of $22.47. While the competition for diabetic testing supplies was intended to apply only to mail-order suppliers, it is important to note that the American Taxpayer Relief Act of 2012 (ATRA), which was signed into law on January 2, 2013, sets Medicare payment amounts for retail diabetic supplies at the national mail order competitive bidding single-payment amounts, effective July 1, 2013. In other words, as a result of the ATRA, the competitive bidding process is being used to reduce pricing for DMEPOS other than items that actually were subject to competitive bidding. This policy was adopted despite CMS’s previous acknowledgment that "there are pricing differences between mail order and non-mail order diabetic testing supplies because of the delivery methods for these supplies." Even though under competitive bidding program rules, only successful bidders that sign a contract with CMS will be eligible to furnish mail order diabetes supplies to Medicare beneficiaries as of July 1, 2013, Medicare beneficiaries will not be limited to using contract suppliers to obtain retail/storefront diabetes supplies. In sum, a Medicare beneficiary must use a contract supplier to obtain mail order diabetic testing supplies, but can pick up diabetic testing supplies from any local retailer; the payment to the supplier and the beneficiary copayment will be the same in either setting. (The ATRA also temporarily reduces fee schedule amounts for retail diabetic testing supplies to mail order amounts from April 1, 2013 until the national mail-order program single payment amounts start on July 1, 2013.)
CMS next will be mailing contracts to “winning” bidders. According to a CMS fact sheet, 14,654 contract offers will be made to 867 Round 2 bidders, who have 3,109 locations to serve Medicare beneficiaries in the CBAs. CMS also will offer 15 contracts for the national mail-order program; the national mail-order program winners have 48 locations in all. CMS notes that about 62% of Round 2 winning suppliers are small suppliers (gross revenues of $3.5 million or less), and 33% of national mail-order contract offers will go to small suppliers. When the contracting process is complete, unsuccessful bidders will be notified of the reasons they were not offered a contract. CMS expects to announce the names of the contract suppliers in the spring of 2013. CMS and the Competitive Bidding Implementation Contractor (CBIC) also will be stepping up educational activities leading up to implementation of Round 2 and national mail-order bidding."Cheers!
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I am curious what input that all of us Diabetics have had into this process that seems at a very advanced stage. Did I miss notices requesting input and feedback from all of us diabetics so affected by what seems as sweeping decisions made behind closed doors without any consensus. On those directly lobbying for Diabetics - have they been part of this decision process and status.
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Permalink Reply by sdkate on
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Although not on medicare yet, I am a medicaid recipient. Yesterday I got a notice that my supplies would no longer be accepted with medicaid payments.....so started looking for another company that would pay for my supplies or at least turn them into medicaid for me. Out of 10 companies I contacted 6 will no longer submit to medicaid. GREAT! NOT. Without that help I do not have resources to pay for strips or testing supplies. I did at the end of the day get a call from CSS and they will take my medicaid payments, but I worry about for how long, My husband is 63, not eligible for medicare yet, and his work insurance stinks as far as diabetes supplies is concerned, So don't know where to look for help with his supplies. What happen to those happy golden years we were always told about?
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Permalink Reply by WyoWiseGuy on -
When I use my allotment of strips for my freestyle monitors, and still have a few weeks before my insurance covers fresh Ines, I turn to the Relion monitor and strips from Walmart. $20 for 50 strips... better than going without, and certainly better than $70 for Freestyle atrips
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