I have Health Net Seniority plus. For two years my one touch ultra strips were covered as DME through mail order. January 1, 2021 it changed to any network pharmacy. Worked for two months and now won’t pay. Health Net said Apria, Edgepark, or Shield covers them but none of them do test strips anymore. So what do I do now?
If changed to pharmacy benefit, why did they give you DME providers?
Do you have a local pharmacy covering meds for your plan, and check if they will cover the bg strips?
Is your plan an Advantage Plan?
Do you use a CGM such as Dexcom or Libre? If you do, Medicare will no longer cover test strips.
It appears that it is. This is from one of the employers that uses the same named plan.
You are enrolled in Health Net Seniority Plus Employer (HMO)
You are covered by Medicare, and you have chosen to get your Medicare health care and your prescription drug coverage through our plan, Health Net Seniority Plus Employer (HMO).
There are different types of Medicare health plans. Health Net Seniority Plus Employer (HMO) is a Medicare Advantage HMO Plan (HMO stands for Health Maintenance Organization) approved by Medicare and run by a private company. [emphasis added]
Yes this is health net seniority plus employer. My pharmacy (which should be covered) submits and it’s denied. Then the DMEs that health net says will cover it state they don’t do test strips anymore. It’s catch 22, like health doesn’t seem to know they changed the rules. I’m calling again to see if I can get anywhere
This is my fundamental objection to Medicare Advantage plans. They can change the rules and formularies at any time, even mid-year. Does this seem like the kind of organization that will stand by you financially when a serious and expensive health crisis hits? These plans love you when you turn 65 but not so much when you turn 75.
I value my traditional Medicare plan combined with a supplement, even though that supplement is a private insurance company. I maintain maximum choice of providers without needing to deal with the current non-coverage circumstances you write about.
My employer pays for it or I would do the same as you!!
Hi, see if this is any help: Medicare Rights Center National Helpline: 800-333-4114
Thanks for the hone number!!