Not sure if this is the right place to ask. Does anyone know if Medicare still requires Dr. visits every 3 months for pump users? I can’t get my next appointment for 5 months with my Endo. It seems all Dr. offices are backed up since COVID. Wondering if Medicare relaxed the 3 month requirement. Thanks.
The requirement has not been changed. If the front office people can’t manage to get you an appointment in time, I suggest that you message your endo directly and tell him/her of your dilemma. My endo has repeatedly told me that she would stay late or miss her lunch to fit me in if I ran into Medicare problems.
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Thanks - sounds like you have a very good Dr. I told the reservationist about the 3 month requirement when I was checking out today & she said they would put me on a cancellation list. I was just hoping medicare might have changed the requirement. Thanks again.
Just remember - any medical doctor will do for the 3-month visits(90 Days, not 3-month, and yes it does make a difference), so if your endo can’t see you, try your PCP, urgent care, etc. The rule is hard and fast but whom you see, medicare does not appear to care so you certainly can find someone licensed to see you.
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My CDE “sees” me by telephone 3 out of the 4 required annual visits. The 4th one is in person and that is also when I get blood taken for labs. See if your endo or one of your other doctors or a CDE will do telephone visits. They count.
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Don’t count on this as being accurate. But Optum Rx has told me there is no requirement to see a doctor every 3 months for my Omnipod supplies. That seems to be the case as my last 2 visits have been 4 or 5 months apart and I’ve had no issues. I gather maybe because the pods are done by pharmacy.
With my endo, I first made two appointments, 3 months and six months. Now at each visit I make a six month appointment which has never been a problem.
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sort of. I’ve gone 4 months on occasion without getting whacked by the Medicare police.
My last 3 endos required quarterly visits to go over my A1c, among other things. I use my A1c as a gage to tell me how well I’m doing.
Generally a good indicator. But cgm or frequent bg logs can show possible areas of lots of highs and lows that result in misleading degree of good control, due to averaging.
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I only said “a gage”, not the only one. It’s independent of pump reads.
I have been on a pump for over 8 years. I visited my Endo every three month until two years ago when he switched me to every four months.
Omnipod is covered by Part D which is handled by private insurance and thus you don’t have the same requirements as Basic Medicare. Supplies for tubed pumps are under Medicare Part B and have the 3-month visit requirement.
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Do you have an Advantage Plan or a Retiree plan? Medicare suppliers will not ship supplies without the 90-day visit with one’s medical professional
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Medicare Group Advantage.
In most Medicare discussions, we usually assume that we have the same “Medicare.” But we don’t. With an advantage plan, you have a private insurance company providing your Medicare benefits. You do not have Medicare as administered by the federal government as those of us with original Medicare have. Advantage plans can set some of their own rules and your insurance company is wise not to require the 3-month visit for pump supplies.
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Thanks for your clarification on this (and similar tips on medicare in other posts). It helps prepare me for when i will start medicare. Still on the fence on standard MC vs Advantage plans. Will revisit posts like this in the future!
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Under my Medicare Advantage plan, my co-pay for the visit, including a comprehensive lab test is $10.
Medicare Advantage (MA) plans contain attractive benefits. It’s part of their marketing plan. Don’t kid yourself, however. Insurance companies employ intelligent and talented actuaries and thinking you can outsmart their calculations is like betting against the house in Las Vegas.
MA plans can change their formularies and participating doctors without much notice. What I would fear the most is facing a daunting life-threatening diagnosis and finding the preferred specialists are not covered by my MA plan. By the way, the strategy of MA plan companies is to sign up as many young and healthy retirees as they can and then nudge them back into traditional Medicare when serious and expensive health set-backs occur.
It is possible to switch back to traditional Medicare after participating in an MA plan for years. What is lost, however, is the ability to sign up with a Medicare Supplement plan (covers the remaining 20%) at that time without going through underwriting. In other words, the supplement companies can say, “no,” or set a high and unaffordable price. Many people currently on MA plans are not aware of this.
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The last I encountered this issue it was 6 months, as was quoted to me by a Dexcom repr and then reaffirmed by my Endo. That was last September so I don’t know if anything changed in the interim.