Medicare - What I've learned

I've mentioned elsewhere that I've been engaged in the Great Medicare Battle since 11/1 when I should have been getting benefits. I thought I'd post on here what I've learned for anyone else going through it or about to.

First I should say that my insurance coverage is a bit atypical. Most people have "regular medicare" and then get a "supplement" to cover what medicare doesn't. I have "CalPers Medicare". CalPers is the California state employees insurance (Anthem)that I had before this and CalPers Medicare is an integrated system where the two work together to provide very good coverage....but very complicated logistics! I'll try and differentiate what I think applies to all Medicare recipients from what might just apply to CalPersMedicare or perhaps other integrated systems.

First of all I did the required applications, got my card, a booklet, etc so thought I was good to go. Then I went to get my test strips and that's where the confusion ensued. First roadblock: My Medicare drug coverage application had been denied, though nobody told me this! The reason was because my mailing address is a post office box. In some rural areas we have no mail delivery so that is where we get our mail. So if you also have a P.O. Box follow up to make sure you don't get denied (and not told about it!)

Next, as you may already know, as of July 1, "diabetes supplies" - as in test strips, lancets, etc are covered on Part B of Medicare rather than Part D (drug coverage) What you may not know, and nobody is going to tell you this is that insulin (and syringes) are still covered on Part D. However, insulin for use in a pump is covered on Part B. I don't know what this means for you, but for me it means the difference between paying $100 for a 90 day supply or paying NOTHING. So be sure and make this known to your pharmacy. Warning: They may have no clue as to how to code this in their system to bill it and it may take awhile so leave time before you need your insulin.

Finally, and this one may only apply to my CalPers insurance, but perhaps to your combination as well: When I went for my test strips they told me I had to pay the deductible. I had read my booklets and knew I had no charges at all on Part B for strips and insulin so I said "I don't have any deductible". Another round of calls to two separate organizations. Turns out Medicare Part B does have a deductible but in my case my Anthem pays it and I have no charge. After numerous delays and with a day of strips left I finally resigned myself to the fact that I would have to lay it out but was reassured by Anthem a form would be mailed to me for reimbursement.

Whew! Hope this long post helps someone and perhaps others will share their experiences as well.

Diabetic test supplies and Insulin for use in Insulin Pumps has always been covered as DME under Part B. The July 1 date comes in with Competitive Bidding requiring you to mail order these supplies. Under some areas and insurance plans, you can still get test strips at some pharmacies. For those looking for a local pharmacy that files insulin for insulin pumps under part B, try your local Walgreens. If the local Walgreens does not understand what to do, have them call corporate to learn how to process the claim.


Hi Steve. I'm new to Medicare so sorry if I put incorrect info about what changed July 1. I was actually told the opposite about the Competitive Bidding: Caremark told me they no longer have the "contract" for diabetes supplies and that I needed to use CVS or Walgreen's. CVS confirmed that it can no longer be done by mail order because of Medicare tightening up supply due to lots of fraud. Perhaps, as you say, Steve, this varies by insurance.

Zoe, thanks, I'm already dreading the transition in <2 yrs! Very helpful.

I was actually looking forward to it, jrtpup as for me it meant going from 80% coverage to 100% coverage on everything but meds. It still does mean that and in addition the Insulin and Test Strips are 100% covered. So I'm confident that once I get through this transition I'll be pleased. I pick up my insulin today so I'm just about there.....hopefully!

I hope I have the same experience! Glad it's working out for you ;)

Zoe, I am on medicare and have anthem as my supplemental. Anthem holds the part D contract. Anyway, I found it is a mess. Part D is paying for insulin, test strips, the entire show, even though much of mine is a part B cover expense. It is a mess.

Zoe–good info, thanks! Question–I know I’ve read threads where you have said you aren’t on a cgm, but I wondered if you knew for sure if Medicare or Obamacare would cover CGMs for Type 1s or not for those that want them?

I don't know from personal experience, Denise, but everything I read on here says they don't cover CGM's. Perhaps that will change in time? My guess is with the Affordable Care Act that it is dependent on what coverage you choose.

As I've said, Rick, mine might be different because it's an integrated system, but I know it applies to all people on Medicare for Test strips to be covered on Part B and insulin if you're on a pump. If it makes a difference to you financially I would check into that further and ask to speak to a supervisor if you are not satisfied with the response. My experience is definitely that you need to advocate for yourself with Medicare.

That’s interesting Zoe…I sure hope that DOES change in time…such as when the Animas Vibe (pump/cgm comes to market–which literally should be any day now).

More information: I just got my second request for blood sugar logs. The first one was from Animas (regarding Medicare requirements) and I just xeroxed my logs along with the labwork they required.

This second one was from CVS (one of my prescribers). It gave me a form I need to fill out for 28 days which is a real pain. But it made it very clear that they can alter my prescription according to what I show as my use in that form. It said that the normal amount for "insulin dependent diabetics" is, I believe 300 for 90 days or 4 a month (I don't have the form with me at the moment). And that to over ride that amount you need to show how many you use. I currently get 10 a day. I routinely use 8 a day but then we all know there are times we are high or low and we test more as we correct. But if I show 8 a day, they could reduce my amounts! Let's hope that in the 28 days there are some days I use more to average out. It really pisses me off that after 4 years of using an average of 10 a day someone can come along and tell me that's too much! What are they thinking, I get my good results (which save money on health care!) by ignoring my blood sugar?!

Zoe - Is that 28-day log for the last 28 days or is it a record for the next 28 days? I would be tempted to make sure that the CVS log has a minimum average of 10/day. I wonder if any other members here have filled out this CVS log.

here is what they are thinking:

It said to "start log when you receive it". I'm currently away from home for a few days and I don't log much when I'm away, so I'll do it when I get back. I was going to make sure it averaged out (though it probably will on its own) but I may be more diligent than that. I don't trust those people!

Thanks, Karen; always good to know their thought process, though any thought process that says a "typical" insulin dependent diabetic only needs to test three times a day is outdated and frankly negligent and economically unsound. IMHO of course!

Zoe, I'm amazed you managed to figure all of this out! I hope that you will not have to pay the deductible for the test strips up front each time, they should just cover it. Thanks for sharing all this. Regarding your other form, I don't see how they could give you 100 per month, or 3-4 per day? I wouldn't even be able to eat meals with that, crazy! There are some days I use more than 15 if I have a bad high or low, which has happened a lot lately. If I were you I would try to test a little more because as we all know, there will be times we may need to test a huge amount, errors and so on which will diminish supplies for our average testing.

I don't think anyone insulin dependent who is on mdi and who has no cgm could ever test that little. Unless they always stay the same, no matter what which I don't think anyone does, pump or mdi. I think the average somehow came from medicare based on their idea of type 2 treatment which is also not good.

Alas, if they based their idea on the best T2 treatment guidelines, they would recommend about 6 tests per day following the Joslin DOIT program recommendations for T2 which includes tests before and after meals. They seem to be following the guidelines of Dr. Kevorkian's HMO.

The maximum allowance is 3; the minimum number of tests per day to be approved for a pump is 4. Go figure.