Alleviating the Confusion over New Changes around Diabetes Supplies
The Medicare rules for ordering diabetes supplies through a mail-order pharmacy have changed. Here is the information you need to know to make this transition smoothly.
On July 1, a Medicare rule took effect that impacts beneficiaries who get their diabetes testing supplies via mail order. It’s referred to as the Medicare National Mail-Order Program. Under the new ruling, beneficiaries must buy their diabetes supplies, including blood glucose trips, lancets, lancet devices, batteries and control solution, through a list of designated vendors, or Medicare national mail-order contract suppliers. Beneficiaries who pick up their testing supplies from a local pharmacy can still do so, but they need to make sure that the store accepts Medicare "assignment" to avoid higher charges for the supplies.
At Joslin Diabetes Center, we are closely monitoring this new program which is intended to be a cost-cutting measure. If you have questions or difficulties navigating the new system, we provided you with additional details to ensure the program is not a disruption to your diabetes care.
Who is affected?
Medicare beneficiaries in all 50 states, D.C., Puerto Rico, the U.S. Virgin Islands, Guam, and American Samoa, who have Original Medicare, are impacted. These changes do not apply to Medicare Advantage plans (like an HMO or PPO). If you are enrolled in a private plan through Medicare, you can contact your plan to find out which suppliers you can use.
How can I get my supplies?
If you want diabetes testing supplies delivered to your home, you must use an approved Medicare national mail-order contract supplier in order for Medicare to help pay for the supplies. To find a contract supplier, you can call 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov/supplier.
Alternatively, Medicare will still cover your diabetes testing supplies if you buy them at a local Medicare-enrolled pharmacy or other store.
TIP from the American Diabetes Association: If you buy supplies at a pharmacy or other store, be sure to ask if the store accepts "Medicare assignment!" This means the store will accept the Medicare-approved amount as payment in full, and you cannot be charged more than 20% coinsurance (after you meet your deductible). If a local store does not accept Medicare assignment, you may be charged more than the 20% coinsurance. Be sure to check with the store to find out what your payment will be.
What will I pay for diabetes testing supplies?
After you have paid your annual Medicare Part B deductible, Medicare pays 80% of the Medicare-approved payment amount for supplies and you are responsible for 20% of the cost (called a 20% coinsurance). The coinsurance may be covered by supplemental insurance, such as a Medigap plan, if you have such coverage. Medicare’s approved payment amount will be the same whether you buy your diabetes testing supplies at a local store or have them delivered to your home. National mail-order contract suppliers and local stores that accept assignment can’t charge you more than 20% coinsurance.
Will a mail-order contract supplier switch me to a different brand even if I like my current brand?
No. Mail-order contract suppliers are not allowed to influence you or give you an incentive to switch to a different brand of glucose monitor and testing supplies. The National Mail-Order Program for diabetes testing supplies does not require that you change your glucose testing monitor. Mail-order contract suppliers must provide the brand of testing supplies that works with your monitor. If the contract supplier does not carry your brand of supplies, you can ask them about other brands, but the supplier cannot give you information about different brands unless you ask.
For More Information
- To find a Medicare supplier in your area and for more information, call 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov/supplier.
- Free health insurance counseling and personalized assistance for Medicare beneficiaries is available in every state through the State Health Insurance Assistance Program (SHIP). Call 1-800-MEDICARE (1-800-633-4227) to find the telephone number of the SHIP office closest to you.
For More Information
- To find a Medicare supplier in your area and for more information, call 1-800-MEDICARE (1-800-633-4227) or visit:
- Free health insurance counseling and personalized assistance for Medicare beneficiaries is available in every state through the State Health Insurance Assistance Program (SHIP).
Call 1-800-MEDICARE (1-800-633-4227) to find the telephone number of the SHIP office closest to you.
Page last updated: August 18, 2016