Mass Health (MaHealth) covering insulin for pump? Medicare is my primary


#1

This question is for people in Massachusetts. I have run into a serious problem. I am on Medicare (primary) and Mass Health (secondary). I have been on a pump for 5 years. For 5 years, my Medicare Part D erroneously covered my insulin, despite the fact that they do not pay for insulin for anyone on a pump. That’s right, they didn’t catch the mistake for 5 years.

When someone is on a pump and whose primary insurance is Medicare, Part B pays for the insulin. However, they only pay 80%. I tried to get Mass Health to pick up the rest but they refused. I have been on the phone with countless people, gone back and forth with the pharmacy helping me.

If there is anyone out there who is on a pump and who has Medicare & Mass Health, please talk to me. I don’t know what to do. I cannot afford to pay 20% of my insulin costs. If I can’t straighten this out I will have to go off of a pump and back on pen shots.

Thanks.


#2

Sorry I can’t help with Mass issues, but your statement is something that I wish every:
1)pumper knew
2) every pharmacist knew
3)every endo knew

It’s sad to know so few people are aware of this Medicare coverage thru part B.


#3

Dave, Thanks for your note. I didn’t realize people were unaware of this coverage. Are people on Medicare just paying cash? This is shocking. Kelly


#4

no, what they are doing is paying copays that they shouldn’t be. But I wouldn’t doubt some give up fighting “city hall” and pay out of pocket. Sort of like I see so many people posting online that they pay out of pocket for strips because they THINK that their insurance won’t cover as many strips as they need. That is nearly 100% a fallacy: and I blame it on a lack of knowlege and/or lazy-&ss doctors. All that is needed to get as MANY STRIPS AS ONE NEEDS, is to have the doctor fill out a “quantity override” form that is faxed to them. It is very simple, yet I see time and time again, people writing in forums that they can’t get all the strips that they need. It’s sad that ignorance of rules and paperwork has cost people money or worse yet, access to the products that they need to protect themselves from serious high and low blood sugars, be it insulin, or strips.

Even on Medicare I am able to get as many strips as I need, and that includes when on a CGM. “Standard” shipments of Medicare-covered G5 shipments from Dexcom include 150 strips. I get 300. If I needed more (I don’t), I could get even more. Just a matter of paperwork. That’s why we have doctors whom have the ability to write prescriptions for their patients.

Knowledge is power. Thats why I have always been a big question-asker. It might have irritated classmates, but I didn’t (and don’t) care. I can’t learn when my mouth is running, except when I’m asking a question to which I get an accurate response.


#5

That has served me well too. In this case, the insurance company doesn’t seem to know their butt from a hole in the ground.