The Medicare Mystery

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Understanding the federal government iscomplex, and the Medicare program can beeven worse.

Working with Medicare is one of the biggestchallenges for people seeking coverage ofdiabetes supplies and services.

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

Tim should know, because his nationalmail order diabetes company specializes inhelping people who have Medicare insuranceget their testing and insulin pump supplies.

Medicare is the nation’s largest healthinsurance program, covering about 40million people. You are probably eligible forMedicare if you are disabled, have reachedyour 65th birthday or have permanent kidneyfailure treated with dialysis or a transplant.

If Medicare is an enigma that you haven’tunraveled, this column can help.

Once the deductible has been met, MedicarePart B will generally pay 80 percent of thecost of blood glucose testing supplies. Yoursupplemental insurance, if any, will usuallypay most of the balance.

Medicare is difficult to navigate now, but formost of us, it was impossible six years ago. InJuly 1998, Medicare expanded coverage ofblood glucose meters and test strips for allpeople with diabetes. Earlier, it covered bloodglucose monitors and test strips only forpeople with insulin-dependent diabetes.

Medicare will cover everything you need fortesting, whether you use insulin or not. Thisincludes:

  • the meter itself
  • test strips
  • lancets

But Medicare sets some low test-supplylimits. If you use insulin, the standard limit is100 test strips and lancets every month. If youdon’t use insulin, the standard limit is 100 teststrips and lancets every three months.

The government seems to think that we testfor the fun of it. Three tests a day when youuse insulin and just once a day if you don’t isfar fewer tests than many of us need.

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

When you need to test more often thanMedicare’s limits, the prescription also hasto give specific reasons. These can includefluctuating blood glucose, uncontrolledblood glucose, hypoglycemia, hyperglycemiaor an adjustment in your medication.

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

A: The Internet has two excellent resources:

  1. The Official U.S. Government Site for People WithMedicare at medicare.gov. Search for “MedicareCoverage of Diabetes Supplies and Services.”
  2. Medicare’s detailed regulations are available on theWeb sites of each of Medicare’s four Durable MedicalEquipment Regional Carriers (DMERCs). Each of theseDMERCs have the same regulations, and the easiest tofind and use is that of Palmetto Government BenefitsAdministrators at http://palmettogba.com. Search for“Chapter 38—Home Blood Glucose Monitors.” It is thefirst link returned.

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