CDISNM Blog
Diabetes is one of the most common health conditions among seniors, impacting 25.2 percent of adults over age 65. Millions more are underdiagnosed or living with pre-diabetes. Original Medicare covers free diabetes screenings for those who are at risk and pays for many services and supplies for those who currently have the disease. If you have recently been diagnosed, and you’re wondering what to expect from your Medicare coverage.
Diabetic Supplies and Services
Medicare Part B covers blood sugar self-testing equipment and supplies including glucose testing monitors and test strips, lancet devices, lancets, and glucose control solutions for testing the accuracy of testing equipment. There may be limits to how much or how often you can get these supplies, and you may be required to use specific suppliers. If you use insulin, you may be able to get more test strips and lancets than someone who does not use insulin. Part B also covers foot exams and treatment (including therapeutic shoes or inserts), yearly eye exams and glaucoma tests, insulin pumps and the insulin used by the device, nutritional therapy services, and diabetes self-management training to help you learn how to better manage your disease.
Factors That Influence Cost
The amount that you need to pay for many of these services and supplies varies. However, some factors can influence your cost. For instance, where you receive treatment, and whether or not your doctor accepts Medicare assignment can impact your cost. Note: Medicare does not cover all recommended diabetes treatments. If your doctor suggests you receive additional supplies or services beyond what Medicare covers, you may have to pay some or all of those costs.
National Mail Order Program
As long as you use a Medicare national mail-order contract supplier, you can have important diabetes testing supplies delivered right to your home. Medicare pays for test strips and lancets to be sent to you by mail. Or, you can pick them up locally at a drug store near you. In either case, you pay the same, whether you receive your testing strips in the mail or purchase them elsewhere. Local stores that accept Medicare assignments cannot charge more than your 20 percent coinsurance, and any unmet deductible.
References:
https://www.medicare.gov/coverage/diabetes-supplies-and-services.html
https://www.medicare.gov/Pubs/pdf/11022-Medicare-Diabetes-Coverage.pdf pg. 6, 7, 8, 10, 11
https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf pg. 2
MUC64-2017-BCBS
CDISNM Blog
There’s no question, that navigating the world of Medicare can be complicated, time-consuming, and frustrating. With many different options, varied plans, enrollment rules, and more, it’s easy to make mistakes. Errors can be costly, which is why it’s so important to understand common pitfalls. Here are the top ten Medicare mistakes, and how to avoid them.
1. Failing to Sign Up When You Are First Eligible
With more people working beyond the age of 65, it’s not uncommon to delay signing up for Medicare—and that’s okay. As long as you have health coverage after age 65 through an employer or a spouse, you can delay enrolling in Medicare without paying a penalty. However, if you do not have group coverage, the right time to sign up is during your Initial Enrollment Period. This is the seven-month period of time that begins three months before your 65th birthday and ends three months after. There are also Special Enrollment Periods for those with unique circumstances, such as losing their job. The important thing to remember is that if you fail to sign up for Medicare when you are first eligible and delay Part B enrollment without proof of other health coverage, you could end up having a lifetime late enrollment penalty added to your premium.
2. Not Taking Advantage of Annual Enrollment
Medicare Annual Enrollment takes place each year between October 15 and December 7. This is the time for everyone to evaluate their current Medicare plan to see if changing plans makes sense. Cost and coverage can vary from year to year, and taking the time during Annual Enrollment to review your plan is smart.
During Annual Enrollment, you can switch from your Original Medicare to a Medicare Advantage Plan, switch from one Medicare Advantage Plan to another, or return to your Original Medicare. You can also join a prescription drug plan, change plans, or drop one that no longer meets your needs. Not taking advantage of this opportunity means you could end up paying more for your plan or keeping a plan that doesn’t fit your changing needs.
3. Thinking You Don’t Need Prescription Drug Coverage Because You Don’t Take Medicine
One of the biggest mistakes people make concerning Medicare is failing to think ahead. If you are healthy and do not take prescription medication, great! However, if you wait to sign up for Part D benefits until you urgently need them, you risk paying a late penalty if you cannot provide proof of creditable coverage for the time you went without.
4. Choosing a Prescription Drug Plan Based on Cost Alone
Cost is a primary consideration when choosing the right Medicare plan. However, with drug coverage, it is often as important to ensure the drugs you use are on the formulary. If you choose a plan based on cost alone and your medication is not listed, you may end up paying much more for what you need.
5. Thinking You Have More Time to Enroll in Part B With COBRA Benefits
After you turn 65, Medicare becomes your primary coverage, unless you have coverage through an employer. However, the coverage must be current, and COBRA benefits or retiree benefits are not coming from a job you still work, and are not considered primary coverage.
COBRA benefits extend an employer’s health care benefits for eighteen months. However, you only have eight months, not eighteen months after your group coverage ends to sign up. If you do not sign up for Medicare during this time, you will have gaps in your coverage and may be responsible for paying a late enrollment penalty.
6. Choosing the Same Plan as Your Spouse
It’s important to realize that you and your spouse likely have very different healthcare needs. When choosing a Medicare plan, whether it’s for prescription drug benefits or Original Medicare, be sure to think about your unique needs and how the plan you’re considering can help you with your medical needs.
7. Waiting Too Long to Enroll in Medicare Supplement Insurance
The good news is, that you have a full six months after enrolling in Part B to join a Medigap plan with full protections in place. All recipients who join Medigap during this period are entitled to “guaranteed issue rights”. This means that no company can refuse to sell you a plan or charge you more for a plan because you have a pre-existing condition. Once these six months end, these protections are no longer in place and you may not be able to get a Medigap plan.
8. Forgetting to Review Your Annual Notice of Change
The Annual Notice of Change that comes by mail each year is filled with critical information on any changes you will see in your Medicare coverage for the upcoming year. Changes in cost, network providers, and even formularies (list of covered drugs) must be noted in this documentation. Read it fully to avoid being surprised by higher out-of-pocket expenses or limited access to health care providers.
9. Not Taking Advantage of Extra Help
Medicare has safeguards in place to help those with limited income afford prescription drug coverage. Unfortunately, many Medicare recipients are not aware that they qualify, and could save money on the same plans they pay for each month. Be sure to read about extra help and make notes on whether or not you are entitled.
10. Going Out-of-Network with a Medicare Advantage Plan
Medicare Advantage makes it easy for seniors to receive all of their Part A and Part B benefits as well as a few extras like prescription drug benefits and in some cases, vision and dental care. However, most plans have very strict requirements regarding network providers. Going to a doctor or hospital outside the plan’s network of providers could end up costing you a lot more out-of-pocket.
References:
Delaying Part B
https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/should-you-get-part-b/should-i-get-part-b.html#collapse-3156
Special enrollment periods
https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-sign-up-parts-a-and-b/when-sign-up-parts-a-and-b.html
Open Enrollment
https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/when-can-i-join-a-health-or-drug-plan.html#collapse-3190
Part D Late Enrollment
https://www.medicare.gov/part-d/costs/penalty/part-d-late-enrollment-penalty.html
Medicare and other insurance
https://www.medicare.gov/supplement-other-insurance/how-medicare-works-with-other-insurance/how-medicare-works-with-other-insurance.html
When to buy Medigap
https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/when-can-i-buy-medigap.html
MUC68-2017-SSI:CDIS
CDISNM Blog
If you rely on various medications to maintain your health, it’s good to know that you can secure benefits through a Medicare Prescription Drug Plan, or Part D. But different plans cover different drugs, and it’s sometimes challenging to find a plan that covers the specific medications you use. Here’s some guidance on how to find out if your drugs are covered and what to do if they aren’t covered.
Check the Formulary
Each Medicare drug plan has its list of covered drugs, called a formulary. In most cases, covered drugs are classified into tiers, with drugs in the lowest tier costing less than those in higher tiers. If you are interested in joining a Part D plan, be sure to review the formulary to ensure your drugs are on the list. Remember, each plan is different, with different formularies. If you don’t see your drugs listed, check another plan. Formularies often change yearly, meaning your drugs may no longer be available next year, even if they are covered this year. Sometimes, covered drugs change tiers, or move between classifications. Even if you are happy with your Part D coverage, you must review your plan’s Annual Notice of Change, along with the formulary for the upcoming year to avoid being surprised at the pharmacy.
Some Drugs are Covered By Original Medicare
In some cases, Original Medicare covers drugs that Part D does not. For instance, vaccines, cancer drugs, and certain injectable prescription drugs are covered under Medicare Part B if you receive them in an outpatient setting, like your doctor’s office.
Some Drugs are Not Covered By Medicare
It’s important to know which medicines may be covered under your Medicare health plan, and which are not. Neither Original Medicare nor Medicare Part D provides benefits for over-the-counter drugs. For instance, cough and cold medicine, vitamins, medication for hair growth, and medication designed to treat sexual dysfunction are not covered.
What to Do If Your Drugs Are Not Covered Under Medicare
In the event you realize your drugs are not covered under a current Part D plan or Original Medicare, there are a few things you can do.
Ask your doctor if there are substitutes available. In many cases, formularies do not cover brand-name drugs but do offer coverage for generic, or low-cost alternatives. You can also ask your doctor if there is another drug that may work the same as one that is not available through your Part D.
Request a formulary exception. Medicare is open to listening to your doctor if he or she believes that a specific drug is the only medication that will help your condition. A formulary exception may be granted if your doctor and Medicare agree that the drug is medically necessary for your health. You also have the right to file an appeal should Medicare deny your request for a formulary exception.
Switch to a new Part D plan. Each plan is different, and your drugs may be covered under a different plan’s formulary. If your current plan no longer covers your medication, and you find a new plan that does, you can switch during the Annual Enrollment Period (October 15- December 7) each year.
References:
https://www.medicare.gov/part-d/coverage/part-d-coverage.html
https://www.medicare.gov/part-d/coverage/rules/drug-plan-coverage-rules.html
MUC67-2017-BCBS
CDISNM Blog
Medicare is available for most people age 65 or older, but also for certain people with disabilities who are under age 65. To be eligible, you must have received Social Security Benefits for 24 months, or have End-Stage Renal Disease or Lou Gehrig’s Disease. If you are disabled and wondering if you qualify for Medicare Part A and Part B, here’s some important information that can help.
Medicare With a Disability
Even if you are under 65, enrollment in Medicare Part A and Part B with a disability is automatic. After receiving Social Security benefits or Railroad benefits for 24 months, you will receive your Medicare card in the mail. Look for the card to arrive three months before your 25th month of disability. Note: if you have Lou Gehrig’s Disease, enrollment is automatic, but Medicare benefits are available after your first month of disability. Enrollment in both Part A and Part B is automatic. However, you can opt out of Part B coverage if you choose. Instructions on the back of the card explain how to do so. If you choose not to accept Part B before age 65, you will automatically be enrolled again when you turn 65.
End-Stage Renal Disease (ESRD)
If you have ESRD, you can sign up for Medicare before 65 if you need regular dialysis, or have had a kidney transplant, and meet one of the following:
You worked the required amount of time under Social Security or Railroad Retirement Board.
You are eligible to receive or already receiving Social Security or Railroad Retirement Benefits.
You are the spouse or dependent child of a person who meets the requirements above.
If you are eligible for Medicare because of ESRD, enrollment is not automatic and you will need to enroll in Part A and Part B by contacting your local Social Security office. Benefits typically start on the first day of the fourth month of your dialysis treatments. If you’re covered by an employer group health plan, your Medicare coverage will still start the fourth month of dialysis treatments. Your employer group may pay for the first 3 months of dialysis.
Medicare benefits may start during the first month of dialysis
You participate in a Medicare-certified training program to learn how to administer dialysis treatments from home and are expected to be able to do so. Dialysis treatments continue through the waiting period. Medicare benefits will end 12 months after you stop dialysis treatments or 36 months after you have a kidney transplant. Coverage can be extended if you start dialysis or get a kidney transplant within 12 months of stopping dialysis, or 36 months after receiving a new kidney.
References:
Medicare with a disability: https://www.medicare.gov/people-like-me/disability/signing-up-for-part-b-disability.html
Medicare with ESRD: https://www.medicare.gov/people-like-me/esrd/getting-medicare-with-esrd.html#collapse-3178
MUC56-2017-BCBS
CDISNM Blog
If you are about to turn 65 or already eligible for Medicare, but currently receiving health coverage through your spouse, you may be wondering if you need Medicare. Part A is free for most people, and it doesn’t hurt to sign up even if you have group insurance through an employer. However, there are some things to consider that can help you decide when to enroll in Medicare.
Determine which coverage is the Primary Insurer
The size of your employer often decides whether or not you can delay enrollment in Part B without paying a penalty. In companies with fewer than 20 employees, Medicare automatically becomes the primary insurer, with group insurance secondary. If you learn that your current insurance will become secondary to Medicare, then you should take Part A and Part B when you are first eligible. The reason for this is that secondary insurance only pays after the primary insurer pays, and pays very little. If you choose to delay Medicare, you will not have a primary insurer, and your out-of-pocket costs will be high. On the other hand, if your employer has more than 20 employees and you learn that your group health insurance will remain the primary insurer with Medicare coverage second, then you may not need to enroll in Part B immediately as your current coverage will cover your needs.
Changes After You Become Eligible for Medicare
After determining who will be the primary insurer, look to your benefits. In some cases, group insurance works differently once you become eligible for Medicare. Learn if your benefits will change, and then decide if it’s worth having both types of coverage or delaying enrollment in Part B. Unlike Part A, Part B isn’t free—once enrolled, everyone pays a monthly premium. Find out how your current coverage works once you or your spouse turn 65 and then decide if it makes sense to enroll in Part B or delay enrollment until a later date.
With Group Coverage, You Qualify for a Special Enrollment Period to Enroll in Medicare
The good news is, that if you have group coverage and missed your Medicare Initial Enrollment Period, you can still enroll in Part B without paying a penalty. As long as you have group coverage, you qualify for a Special Enrollment Period. And, you have an additional 8 months after losing group coverage to enroll in Medicare without paying a penalty. You’ll also get a guaranteed right to buy Medicare Supplement Insurance for six months after enrolling in Medicare Part B.
References:
https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/should-you-get-part-b/should-i-get-part-b.html#collapse-5783
MUC64-2017-BCBS
