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Railroad Medicare Coverage of Supplies if You Have Diabetes
Railroad Medicare covers certain supplies if you have Medicare Part B and have diabetes. These supplies include:
• Blood glucose self-testing equipment and supplies
• Therapeutic shoes and inserts
• Insulin pumps and the insulin used in the pumps
Blood Glucose Self-testing Equipment and Supplies
Blood glucose self-testing equipment and supplies are covered for all people with Medicare Part B who have diabetes. This includes those who use insulin and those who do not use insulin. These supplies include:
• Blood glucose monitors
• Blood glucose test strips
• Lancet devices and lancets
• Glucose control solutions for checking the accuracy of testing equipment and test strips
Railroad Medicare covers the same type of blood glucose testing supplies for people with diabetes whether or not they use insulin. However, the amount of supplies that are covered varies.
1. Use insulin, you may be able to get up to 100 test strips and lancets every month, and 1 lancet device every 6 months
2. Do not use insulin, you may be able to get 100 test strips and lancets every 3 months, and 1 lancet device every 6 months
If your doctor documents why it is medically necessary, Railroad Medicare will cover additional test strips and lancets for you.
Medicare and Railroad Medicare will only cover blood glucose self-testing equipment and supplies if you get a prescription from your doctor which includes:
• That you have diabetes
• What kind of blood glucose monitor you need and why
• Whether or not you use insulin
• How often you need to test your blood glucose
Medicare will not pay for any supplies not asked for, or for any supplies that were sent to a beneficiary automatically from suppliers. This includes blood glucose monitors, test strips, and lancets. Also, if a beneficiary goes to a pharmacy or supplier that is not enrolled in Medicare, Medicare will not pay. The beneficiary will have to pay the entire bill for any supplies from non-enrolled pharmacies or non-enrolled suppliers.
All Medicare-enrolled pharmacies and suppliers must submit claims for blood glucose monitor test strips. You cannot submit a claim for blood glucose monitor test strips yourself. You should make sure that the pharmacy or supplier accepts assignment for Medicare-covered supplies. If the pharmacy or supplier accepts assignment, Medicare will pay the pharmacy or supplier directly. You should only pay your coinsurance amount when you get your supply from your pharmacy or supplier for assigned claims. If your pharmacy or supplier does not accept assignment, charges may be higher, and you may pay more. You may also have to pay the entire charge at the time of service and wait for Medicare to send you its share of the cost.
Before you get a supply, be sure to ask the supplier or pharmacy the following questions:
• Are you enrolled in Medicare?
• Do you accept assignment?
If the answer to either of these two questions is 'no,' you may wish to consider calling another supplier or pharmacy in your area that answers 'yes' to be sure your purchase is covered by Medicare.
Therapeutic Shoes and Inserts
If you have Medicare Part B, have diabetes, and meet certain conditions (see below), Railroad Medicare will cover therapeutic shoes if you need them. The types of shoes that are covered each year include one of the following:
• One pair of depth-inlay shoes and three pairs of inserts or
• One pair of custom-molded shoes (including inserts) if you cannot wear depth-inlay shoes because of a foot deformity and two additional pairs of inserts
Note: In certain cases, Medicare may also cover shoe modifications instead of inserts.
In order for Medicare to pay for your therapeutic shoes, the doctor treating your diabetes must certify that you meet all of the following three conditions:
• You have diabetes
• You have at least 1 of the following conditions in one or both feet
o Partial or complete foot amputation
o Past foot ulcers
o Calluses that could lead to foot ulcers
o Nerve damage because of diabetes with signs of problems with calluses
o Poor circulation, or
o Deformed foot
• You are being treated under a comprehensive diabetes care plan and need therapeutic shoes and/or inserts because of diabetes
Medicare also requires the following:
• A podiatrist or other qualified doctor must prescribe the shoes, and
• A doctor or other qualified individual like a pedorthist, orthotist, or prosthetist must fit and provide the shoes to you
Medicare helps pay for one pair of therapeutic shoes and inserts per calendar year, and the fitting of the shoes or inserts is covered in the Medicare payment for the shoes.
Insulin Pumps and the Insulin Used in the Pumps
Insulin pumps worn outside the body (external), including the insulin used with the pump, may be covered for some people with Railroad Medicare coverage who have diabetes and who meet certain conditions. If you need to use an insulin pump, your doctor will need to prescribe it.
Railroad Medicare covers the cost of insulin pumps and the insulin used in the pumps. However, if you inject your insulin with a needle (syringe), Medicare Part B does not cover the cost of the insulin, but your Medicare prescription drug benefit (Part D) covers the insulin and the supplies necessary to inject it. This includes syringes, needles, alcohol swabs and gauze. Your Medicare Part D plan will cover the insulin and any other medications to treat diabetes at home as long as you are on the Medicare Part D plan’s formulary.
Coverage for diabetes-related durable medical equipment (DME) is provided as a Medicare Part B benefit. The Medicare Part B deductible and coinsurance or copayment applies after the yearly Medicare part B deductible has been met.
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