Hello all. I’ve lived with T1D 55-years and graduated to Medicare last year. It’s proved to be a very tough transition and I welcome your suggestions to navigate glucose test strip coverage in the program. I also cannot find Part B aligned suppliers for Skin Tac Wipes, my ‘go to’ solution to keep insulin pumps securely attached for many years.
I’m at a loss to find a local pharmacy or, preferably, a Mail-Order Diabetes Supplier that directly bills Medicare Part B and my Supplement Plan. Here’s where I’m at. Once annual insurance deductible is met, my Glucose Test Strips should be covered 80% by Medicare Part B. Then my Medicare Supplement Plan G is supposed to pay the 20% balance. I figured that’s part of the reason I pay for ‘premium’ premiums.
I checked the Durable Medical Equipment Cost Compare | Medicare.gov link. Problematically, local pharmacies queue when I queue “mail-order” in search. But no locals do the Medicare Part B and Plan G route. Next, since I’ve been stuck paying full out-of-pocket, I submitted claims directly to Medicare and Suppl Plan G to correct claims addresses per various recommendations. Disappointedly, there’s been zero replies or reimbursements to me with over a year of claims. I welcome your supportive advice to get me on the right track. Thanks.
I just talked to medicare about this. You have to get cgm and pump supplies and strips in a bundle form your supplier. They will not pay for them otherwise. They had me look on the medicare supplier list and I will have to call each one individually to make sure they can supply all my needs. I just switched to a 770g and their cgm. I have been using CCS has my supplier with a dexcom cgm and CCS does not have a contract with medicare for test strips so I was never able to find a way to get themcovered.
I am not on Medicare, but I have had T1 for 40 years and spent a season making Medicare sales for an Advantage Plan provider, usually referred to as Part C.
Are you in an Advantage Plan with UnitedHealthcare, BCBS, or another private insurance provider? Test strips are usually covered under Part D of the prescription plan. The exception to this is Part B coverage if you are on an insulin pump and maybe a CGM. Those are DME and covered under Part B, and for some weird rule these are covered under Part B. CGM coverage was not typical in those days.
Once you hit your deductible you are to pick up the 80/20 or your supplement plan will pick those charges up under Part G. Once the out-of-pocket maximum is hit the plan should cover everything at 100%.
I hope this helps you with your needs. Please let us know if you have any additional questions.
I don’t know anything about Plan G. However, pharmacies that bill under Medicare Part B seem to return two entries when searching for providers, presumably one associated with Part D and another for Part B.
I’m on Medicare, and I have BCBS Medex as my supplemental policy. My test strips get covered under my prescription drug plan. Because I’m not on a CGM and I test A LOT, my doc has to justify the number of strips I use once a year, but they do cover my 7 strips a day.
All these suppliers are so strangely different! I switched away from CCS because they could not send insulin free through Part B with my pump supplies as Medicare directs. I am with Advance Diabetes Supply (ADS) now and they supply everything including an off-market glucose tester and strips. But since I prefer Contour Next test strips I am unable to get these covered other than through Part D which is very expensive. I am considering joining Ascensia’s purchase program for test strips next year. [CONTOUR®NEXT Test Strips | Ascensia Diabetes Care] (https://www.ascensiadiabetes.com/products/contour-next-test-strips/)
Since I enrolled in Medicare system a few yrs ago after 50+ years of living with T1D, Medicare makes management and sourcing of diabetes care supplies exponentially more difficult. It’s considerably more time-consuming, frustrating, complex, and convoluted. T1D is a difficult condition on its own!
All in all, my difficult experiences with Medicare plans parallel yours very well. And medical supplies required for each person’s optimal care vary considerably. Yet it’s extremely problematic and impossible or near impossible to readily find any set of Medicare, Supplement, Plan D Providers that cover the tremendously unique patient needs. Finding Suppliers is another nightmare. Get this PDM I need only from here, get the infusions sets only from them, order the CGM and sensors that work best for me only from a different supplier. Then search high and low for Plan D and pharmacy that dispenses a particular insulin that is the only one works for me. Oh, and couple that to find Plan D with formulary that includes my few regular Rxs as well as that specific insulin. Then add another scavenger hunt to find the elusive Test Strip provider that can directly bill Plan B. Working to discover that for three years!
I am now pursuing Insulin Novolog (Aspartate) through CVS who assures me they can use a prescription from my Endo to order insulin at no cost. CVS will also submit my prescription for Contour Next blood glucose test strips through Part B. I will inform you all if this works. CVS pharmacist cannot assure me that it will be approved!?!
On the issue of my ADS supplier, they did call me over this weekend to tell me that they have all the documentation from my Endo to send the Aspartate Insulin to me now free through Medicare Part B. So, it should arrive this Tuesday, July 25th. Fingers Crossed.
CVS did fill the test strip order for 300 Contour Next strips. They charged a strange $10 which we figure was wrong but it was not worth challenging. I will wait for the EOB from Medicare.
So yes, we T1s can get 300 test strips with our Insulin Pumps through Part B at CVS every 90 days.
And we seniors are supposed to keep our stress to a minimum! Yeah, right!