Late January, at my endo appointment, they told me that as of 2016, Medicare is no longer covering the a1c test! Is this true? Doesn’t seem right if they require us to see the doctor every 3months, then what is it for?? I’m puzzled!
FWIW, it doesn’t say that on the official website:
This is news to me. In the official description of “Medicare’s Coverage of Diabetes Supplies & Services” it says that when you have diabetes this test is covered by Medicare if ordered by your doctor. Medicare seems to be silent on whether non-diabetics are granted the A1c (as opposed to a fasting glucose) for screening purposes twice a year. In the case of an insulin pump, Medicare requires that you see a doctor (competent to manage pump patients) every three months for evaluation, it is silent on the A1c but presumably that is a routine part of “evaluation.”
Perhaps others who are on Medicare have had other experiences.
The A1c in Medicare is used to diagnose not to measure your control. If it is ordered by your doc then it may be covered. I would ask. Some of the coverage depends on what additional insurance you may have. That 3month rule is not a true rule unless you are using an insulin pump. It’s just accepted and repeated enough that folks follow it. Why not, the doc gets paid to do nothing! If you use a pump then the 3month is necessary but not for A1c, it’s for test records, they want to be sure you are testing according to another arbitrary rule. This is likely going to change if/when the competitive ruling is eliminated or improved. To even be covered for a pump there is a testing rule. From the IPO who offers the CMS rules for us:
For an insulin pump - The patient with diabetes has been on a pump prior to enrollment in Medicare and has documented frequency of glucose self-testing an average of at least 4 times per day during the month prior to Medicare enrollment.
Continued coverage of the insulin pump would require that the patient has been seen and evaluated the treating physician at least every 3 months. The pump must be ordered by and follow-up care of the patient must be managed by a physician who manages multiple patients with CSII and who works closely with a team including nurses, diabetes educators, and dietitians who are knowledgeable in the use of CSII.
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