Medicare Part B: Coverage of test strips
Daily self-testing of blood glucose is an important part of effectively managing diabetes. Although blood glucose meters make testing convenient, the cost of test strips can quickly add up. Fortunately, Medicare is available to pay for testing strips.
Medicare Part B covers test strips
Andrea Gary works with the Florida State Health Insurance Assistance Program. Known as SHINE, the program is administered through the Florida Department of Elder Affairs and helps seniors residents in the state understand and access Medicare and other insurance programs. According to Gary, the number of test strips covered by Medicare may depend upon whether the patient uses insulin.
"If a beneficiary uses insulin, he or she may be able to get up to 100 test strips and lancets every month and one lancet device every 6 months," said Gary. "If the beneficiary does not use insulin, he or she may be able to get 100 test strips and lancets every 3 months and one lancet device every 6 months."
Dr. Ami Sen, a medical director for the senior division of health insurance company WellPoint, adds that coverage may be impacted by whether an individual is enrolled in original Medicare or Medicare Advantage. While Medicare Advantage plans must cover all the same services as original Medicare, they may also offer expanded coverage.
Beneficiaries must first meet their Part B deductible before Medicare begins paying for the test strips. Then, beneficiaries should expect to pay 20 percent of the Medicare-approved amount for their strips.
How to get coverage for additional test strips
In the event an individual needs more test strips, it may be possible to appeal to Medicare for additional coverage.
"The member's physician can submit a request for an override, and the member or the physician also can request an appeal," said Sen.
Gary also suggests beneficiaries keep careful records to support an appeal.
"If a beneficiary uses more test strips than are allowed by Medicare, he or she should keep records of how many were actually used," said Gary. "All supporting documentation such as receipts and prescriptions should be included with the appeal request."
To submit an appeal, beneficiaries should refer to the instructions on the back of their Medicare Summary Notice. Free assistance may also be available through a State Health Insurance Assistance Program such as SHINE. To locate their state's program, beneficiaries can call the Medicare hotline at 1-800-MEDICARE (633-4227).
Interview with Andrea Gary SHINE, Interview with Amir Sen | WellPoint, Medicare.gov http://www.medicare.gov/publications/pubs/pdf/11022.pdf