Social Security & Medicare Questions: August 2011

Social Security & Medicare Questions: August 2011

Q: What is wrong with Medicare? I spent four days trying to get test strips and lancets for testing my blood. I’ve gotten them at Rite Aide drugs for 13 years with no problem. This time I needed a perscription from my doctor because my old one had expired . When I took it to Rite Aide they took three days to get back to me only to say we had to pay $124 and Humana insurance would reimburse all or part of what I had paid. My husband called Medicare and was told they paid 100%. I am confused and I'm getting very angry because I don't understand. I need to know where I can get my supplies without having to pay up front and wait for some one to decide to send my money back.

A: Medicare Part B covers self-testing diabetic supplies that includes test strips and lancets, and covers the supplies whether or not you use insulin. There may be limits on how much, or how often you get the supplies. To trouble shoot try the following:

1. Call your doctor: Your prescription should say whether you use insulin, how often you should test your blood sugar, and how many test strips and lancets you need for 1 month. If you use insulin, you may be able to get up to 100 test strips and lancets every month, and one lancet device every 6 months. If you don’t use insulin, you may be able to get 100 test strips and lancets every 6 months. If your doctor says it is medically necessary, Medicare will allow additional test strips and lancets.

2. Review your Humana coverage: Are you enrolled in a Medigap plan (like “A” through “L”) with Medicare, or are you enrolled in a Medicare Advantage plan? If you have coverage from one of the Humana Medigap plans, you pay 20% of the Medicare approved amount, AFTER the yearly Part B deductible which is $162 in 2011. If your Medigap plan does not cover the Part B deductible then that might explain why you paid $125 out-of-pocket. If you’re enrolled in one of Humana’s Medicare Advantage plans, you would have different out-of-pocket costs. Depending on your area of the country there may be a deductible, you would need authorization from your plan, pay either a $10 copayment or 20% of the cost of the supplies.

3. Call your plan and request a list of network pharmacies: Is your pharmacy still a network pharmacy for your plan? “Network” does not mean the same thing as “participating.” If it is not a network pharmacy, you may have to pay more or even the entire cost of your supplies. What you describe sounds like Rite Aide is no longer a network pharmacy for your plan. Call the customer service number of your Humana plan or visit online, describe your problem, and request a list of network pharmacies.

4. For more info: Call 1-800-MEDICARE (1-800-633-4227) and request CMS Publication No. 11022 “Medicare Coverage of Diabetes Supplies & Services.