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Getting the Most from Your Health Coverage

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Knowing your health care coverage inside out is an important component of successful diabetes management. Frankly, dealing with this kind of stuff can be frustrating and annoying. But the more you know about what Medicare and your health plan do and don’t cover, the more effective you’ll be as a good partner of your healthcare team.

Know what Medicare Covers
In terms of equipment, here’s what Medicare covers:

  • Any meter
  • If you’re on insulin: 100 test strips per month
  • If you’re not on insulin: 100 test strips every three months
    (If you need more test strips, ask your doctor to write a letter saying so, and chances are good you’ll get the coverage you need.)
  • Lancets
  • Alcohol wipes
  • Lancing device

Medicare does not cover insulin or syringes.

Medicare also covers self-management training:

  • At the initial diabetes diagnosis, you get 10 hours of training with a certified diabetes educator (CDE) or other qualified professional. Of those 10 hours, nine must be in a group. According to Mary Frederick, CDE for Allina, “Getting the training in a group is a real good way to get an education.”
  • Every year after the diagnosis, you’re eligible for two hours of general diabetes follow-up and two hours of medical nutrition therapy.
  • Training must be done by an American Diabetes Assocation-recognized program.

Know Your Health Plan
If you have diabetes, there’s no way around it—you really need to be completely familiar with your healthcare plan. This means:

  • Read it thoroughly to make sure you’re covered before you start a program or treatment
  • If you have trouble figuring out exactly what your policy says (and it’s common to have trouble understanding your plan), call and find out if a program or treatment is covered. Don’t be shy about calling. The wording in the literature your plan sends you can be difficult to understand.

If Your Plan Denies Coverage, Be Persistent
When your plan tells you that something isn’t covered, don’t assume that’s the final word. Call them and find out why. Find out if there’s anything that can be done to reverse the decision. Maybe you need to send them additional documentation. Maybe you need a letter from your doctor. Maybe they made an error. Mary Frederick reminds us that,“It’s definitely worth it to keep at it and not take an easy ‘no’ for things you think should be covered.”

Source:
Mary Frederick, Registered Dietitian, Allina Hospitals and Clinics.



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