Does Medicare Pay For Glucose Monitors?

Continuous Glucose Monitors (CGM’s) are life savers for many insulin dependent diabetics. Medicare does cover diabetic supplies and medications but it is the way those items are covered that can be confusing. Not all diabetics need a pump. Not all diabetics that need a pump need a CGM. Some are able to manage their disease with either oral medication or by injection.

CGM Continuous Glucose Monitor CGM

If your doctor certifies to Medicare that you meet their criteria for an insulin pump then maybe Medicare will cover the device.

Or maybe they won’t.

And Medicare might pay for some glucose monitor’s but not for others.

Confused?

Read on.

 

CGM’s and Medicare

A CGM can be an insulin pump but not all insulin pumps are CGM’s.

In insulin pump is an implantable device used to administer insulin rather than using a syringe and needle. Pumps can be programmed to release small doses of insulin in much the same way as your pancreas does. By delivering “mini” doses of medicine the need for long acting insulin is eliminated.

A Continuous Glucose Monitor continuously measures your glucose levels but not your blood glucose levels.

Medicare covers therapeutic CGM’s but not adjunctive CGM’s.

 

Medicare Part B and Part D

Insulin is covered under Medicare Part D (drug plans) unless it is covered by Part B.

Screening for diabetes is covered by Medicare Part B . . . unless you need more than two screenings per year.

Medicare Part B pays for glucose monitors, lancet’s, test strips and most other Durable Medical Equipment (DME) but they do limit the quantity and how often you can get these supplies.

If you use insulin Medicare covers up to 300 test strips and lancets every 3 months. But if you do not use insulin Medicare covers up to 100 test strips and lancets every 3 months.

Apparently Medicare believes you do not need to test your blood sugar as often if you are not insulin dependent.

Medicare Part D covers insulin unless it is covered by Part B.

Medicare may pay for Continuous Glucose Monitor sensor’s but only if your monitor is a specific brand. Sensors are devices planted under the skin to monitor and relay information about your glucose levels.

Medicare has approved the Dexcom G5 CGM but only if you use the receiver that comes with your device but not if you use a smart phone app.

Do you really think Medicare will track everyone who has a Dexcom G5 to see if they are checking their glucose on their smart phone? And why should Medicare care if you use your smart phone or not?

Medicare Advantage or Medicare Supplement

If you have a Medicare Advantage plan in many cases your plan will pay 80% of the cost of your pump or CGM and you will pay the remaining 20%. Monitors run anywhere from $1000 to $1400 plus another $300 or so each month for sensors. And you will need a battery that is changed about once a year or so. They run around $500.

With an Advantage plan your out of pocket costs can get expensive over the course of a year.

Medicare Advantage plans are purposely designed to maximize your out of pocket expense while minimizing the carriers out of pocket.

For those with original Medicare and a supplement plan your out of pocket cost for a pump and approved continuous glucose monitor can be $0 if you have Medigap plan F.

And let’s not forget insulin.

Many Advantage plans run your insulin through the drug plan portion of your coverage.

Unless your Advantage plan does not cover prescription drugs. Then your insulin may still be allocated to Part D. Insulin under Part D can run $300 – $500 monthly depending on the type of insulin and dosage. It also varies by where you are in regard to the donut hole.

 

Medigap and Your Diabetes

Under original Medicare, if you have a pump, with or without a CGM, your insulin is covered by Part B. That means your out of pocket cost could be $0 for the year if you have a Medigap plan.

The BEST time to purchase a Medicare supplement plan is when your Part B goes into effect and you are turning 65 or older.

Georgia Medicare Plans specializes in helping seniors find Medicare supplement plans with the lowest premiums in their area. Our exclusive report shows you every Medigap plan in your area based on your age and gender. No need to waste time searching for the best rates. We shop, you compare. Call or email.

You can also run your own Medigap quotes from the comfort of your home.

CGM Monitors - Georgia Medicare Supplement Rates

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Does Medicare Pay For a CPAP

Does Medicare Pay for CPAP

Many people over  65  on Medicare have some form of chronic sleep apnea and need a CPAP machine. Most go undiagnosed so only a small percentage use a CPAP. According to the UCLA Sleep Center “It is very common for people over the age of 65 to have problems with their sleep. Insomnia is their most common complaint. Many drugs used to treat medical problems can also disrupt your sleep. Some people are able to sleep better by using sleeping pills from time to time. But many older people rely too much upon drugs to help them sleep. Studies show that some common drugs may not even work well in older people. In fact, they may even make sleep problems worse.”.

A Continuous Positive Airway Pressure device known as a CPAP machine can remedy many of the problems associated with Obstructive Sleep Apnea (OSA).  Not everyone can use the machine and with prices anywhere from $500 to over $3,000 coming up with the money to pay for the machine may be difficult.

Medicare Coverage for CPAP

With so many people over 65 having OAS you would think Medicare would pay for your machine. Actually, Medicare has some of the strictest guidelines for coverage of any health insurance plan. Perhaps that has something to do with also having the most generous coverage with Medicare picking up 80% of the cost of your machine under Part B.

Under the Obama administration the OIG (Office of Inspector General) was directed to find ways to eliminate waste, fraud and abuse in the Department of HHS (Health and Human Services). That report, released in June of 2013, found that “beneficiaries receiving CPAP treatment may have received more supplies than were medically necessary”.

Even though the report showed that the number of supplies did not exceed the recommended replacement schedule it also stated that if someone DID receive more supplies than necessary that would be wasteful spending.

Let that sink in for a moment.

Here are Medicare guidelines with regard to CPAP machines.

Medicare covers a 3-month trial of CPAP therapy if you’ve been diagnosed with obstructive sleep apnea.

Medicare may cover it longer if you meet in person with your doctor, and your doctor documents in your medical record that the CPAP therapy is helping you.

If you had a CPAP machine before you got Medicare, Medicare may cover rental or a replacement CPAP machine and/or CPAP accessories if you meet certain requirements.

If you had a CPAP before going on Medicare and your doctor states that the machine is helping you, Medicare MAY pay for the rental or replacement of the machine.

Your doctor and the AASM (American Academy of Sleep Medicine) may say you have sleep apnea but Medicare may say you don’t.

In other words, until Medicare says you have OSA you don’t have a medical problem that requires a CPAP. You can get the machine if you want, but Medicare won’t pay for it.

 

Competitive DME Bidding

The folks at Medicare want to make sure they get the best price on Durable Medical Equipment so they make supplies bid on contracts for their business. But the game doesn’t stop there.

Medicare will only cover your durable medical equipment (DME) if your doctor or supplier is enrolled in Medicare. If a DME supplier doesn’t accept assignment, Medicare doesn’t limit how much the supplier can charge you. You may also have to pay the entire bill (your share and Medicare’s share) at the time you get the DME.

In an attempt to save money, Medicare imposes a competitive bidding process where DME (Durable Medical Equipment) supplies must compete if they want to be a sanctioned Medicare supplier.

What could possibly go wrong there?

Competitive bidding means fewer suppliers participating in the DME process. Fewer suppliers means delays in getting your equipment. Without a CPAP any related medical conditions can get worse.

But hey, at least Medicare is saving money, right?

 

Getting Medicare to Pay for a CPAP

The good news is, you can get Medicare to pay for your nightly breathing assistance machine. All you have to do is follow their guidelines.

If you are able to convince Medicare you do in fact have apnea, and that your condition will IMPROVE by using a CPAP, they will cover 80% of the cost under Medicare Part B. If you also have a Medigap plan your out of pocket cost could be $0 or limited to your annual Part B deductible.

Advantage plans do cover a CPAP in most cases but your out of pocket cost for the machine and supplies under most plans is 20%. That could amount to several hundred dollars per year. Even more if you fail to use a network approved DME supplier.

Georgia Medicare Plans specializes in helping seniors find Medicare supplement plans with the lowest premiums in their area. Our exclusive report shows you every Medigap plan in your area based on your age and gender. No need to waste time searching for the best rates. We shop, you compare. Call or email.

You can also run your own Medigap quotes from the comfort of your home.

Georgia Medicare Supplement Rates

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#CPAP #OSA #SleepApnea #Medicare #MedicareSupplementPlan #MedicareApvantage

 

 

 

Medicare Part B Premiums Rise In 2016

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Your 2016 Medicare Part B premiums are going up. A lot. So are deductibles. Oh, and Medigap plan F will be retired in 2020. The same year the Part D donut hole closes and you pay more in premiums, copay’s and out of pocket.Medicare Part B premium 2016

What does this mean to you? How will this impact you? What will happen to Medicare supplement plans? If you bought plan F plan your exit strategy.

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Post summary

  • Part B deductible to rise in 2016
  • Part B premiums rise for 2016
  • Changes to deductibles and premiums not finalized yet
  • No Social Security COLA for 2016
  • Medicare supplement plan F to be retired
  • Instant online Medigap quotes

Medicare Part B Changes in 2016

Hold on to your wallet. Next year is going to be costly for many Georgia retirees on Medicare.

Medicare Part B premiums will rise 52% in 2016 from $104.90 to $159.30. If you are receiving Social Security your check will be lower.

soup naziThink the increase will be offset by your COLA increase?

Nope.

COLA increases are not in the cards for next year.

No COLA for you.

 

Medicare Trustee Report

For those who want to go straight to the source, here is a link to the Trustee Report.

The summary from Kaiser Health News distills it down to something mere mortals can understand. Kind of.

The report warned that several million Medicare beneficiaries could see their Medicare Part B monthly premiums skyrocket by 52 percent in January — from $104.90 to $159.30. Medicare Part B, which is paid for by a combination of federal funds and beneficiary premiums, generally covers physician and outpatient costs.

The huge rate hike is predicted because of a confluence of two factors: Medicare Part B costs increased more than expected last year, and Social Security is not expected to have a cost of living increase next year. By law, the cost of higher Medicare Part B premiums can’t be passed on to most Medicare beneficiaries when they don’t get a Social Security raise. As a result, the higher Medicare costs have to be covered by just 30 percent of Medicare beneficiaries. This includes the 2.8 million Medicare enrollees new to the program next year, 3.1 million Medicare beneficiaries with incomes higher than $85,000 a year and 1.6 million Medicare beneficiaries who pay their premium directly instead of having it deducted from Social Security. – Kaiser Health News

But wait, there’s more.

 

Medicare Part B Deductibles Increase in 2016

If you manage to escape the Part B premium increase you will still participate in the Part B deductible increase in 2016. One way or another, you will pay more.higher health care costs

The expected Part B deductible should be $223 in 2016

That is up from $147 in 2015.

If you have straight Medicare, you will pay more in out of pocket.

If you have a Medicare supplement plan F that pays your Part B deductible for you, expect to pay more. Plan F premiums will increase by $100 per year at a minimum.

Probably more in the order of $130 – $150+.

If you have a Medicare Advantage plan you will pay more. Higher premiums, higher copay’s, higher deductibles in any combination.

The only way to avoid paying more is to stay healthy and not incur any outpatient (Medicare Part B) charges.

Lock in lower premiums for plan G now. Shop and compare rates. We have access to over 170 different Medicare supplement plans in Georgia. One is right for you.

Georgia Medigap plans & Prices

Georgia Medigap plans & Prices

 

What Happens in 2020?

The good news is, the Medicare Part D drug plan donut hole will go away. About 93% of Medicare beneficiaries never hit the donut hole but in 2020 no one will find themselves there.

medicare shockThe bad news is, between now and 2020 your Part D premiums will rise as will your copay’s and deductibles. In other words, funding the closure of the donut hole means EVERYONE pays more, including those that would have otherwise hit the donut hole at one point during the year.

There is no free lunch.

The donut hole was included in the plan design to keep costs affordable. Eliminating the donut hole, billed as a benefit of Obamacare, makes your Part D premiums and out of pocket less affordable.

Also, the folks in Congress believe retirees go to the doctor too much and are encouraging them to stop going so much by retiring plan F.

In the interim plan F premiums will skyrocket.

There are two types of people that buy plan F.

Those that just want to budget for premiums and not have to pay Medicare Part B deductibles and coinsurance. For them, it is easier to pre-pay those expenses  by paying a higher premium for plan F.

Then there are retirees that have never been told about anything other than plan F. The salesman or the carrier pushed plan F on them without showing them how they could save $300 per year or more with plan G.  Why did they push plan F?

Because the higher premium means the agent and the carrier make more money.

But you won’t have to worry about that much longer. In 2020 Medigap plan F will be retired.

As a result of legislation just passed by Congress, starting in 2020 Medigap plans will no longer be allowed to offer coverage of the Medicare Part B deductible, which is currently $147 (in 2015). However, current Medigap policyholders and those buying policies before 2020 will still be eligible for the deductible coverage after that date. – Elder Law Answers

If you have plan F now, you can keep it.

But understand that plan F premiums that are already overpriced will become even more so when the plan is no longer an option for new entrants.

Lock in lower premiums for plan G now. Shop and compare rates. We have access to over 170 different Medicare supplement plans in Georgia. One is right for you.

Georgia Medigap plans & Prices

Georgia Medigap plans & Prices

You can read more about changes in Medicare at California Health Advocates along with links to the law.

 

Why are Medigap Premiums Increasing?

Medicare supplement plan F has never been a good buy. Look how much premium difference there is today for an age 65 female living in Clayton, Georgia.

AARP (United Healthcare) plan F premium is $166.

Best rate for plan G with a carrier that has been in the Medicare market for 18 years, $97.

What are you getting for that extra $828 per year?

A bigger hole in your bank account. Next year when the Medicare Part B deductible increases that gap could be $1,000 or more.

Do you really think it is wise to pay a Medicare supplement carrier $1000 to cover your (2016) Part B deductible of $223?

Every time Congress raises your Medicare deductible, plans (like F) that pay the deductible for you will increase premiums accordingly.

Most of my clients have been purchasing plan G for years.

My job is not to convince you of anything. Life doesn’t work that way.

What I will do is educate you on your options and show you Medigap carriers with a proven track record of 5+ years in the Medicare market.

That 5 year threshold eliminates

  • Omaha Insurance Company (less than 2 years in the Medigap market) and does not have an A M Best rating
  • Aetna Health and Life (less than 3 years in the Medigap market)
  • Manhattan Life (less than a year in the market)
  • Catholic Greek Union, CSI Life, Companion Life, CIGNA

And if you want plan G don’t go looking for it with

  • AARP (United Healthcare)
  • Blue Cross (BCBSGA)
  • Humana

They don’t offer plan G.

You have questions. We have answers. We also have the best rates, guaranteed.

georgia_medicare_fb_cvr

 

 

Additional links:

Your Medicare Premiums Could Soar Next Year

COLA Wars in Medicare Part B Premiums

Medicare Trustees Report Projects Large Increase to Part B Deductibles

 

 

#MedicarePartBPremium #MedicarePartBDeductible #MedicareSupplementPlanF #DonutHole

 

Medicare Changes Cost Retirees

Proposed Medicare changes in the way doctors are paid could mean YOU pay more for your health care. While Congress mad at congresstries to contain the cost of Medicare it is obvious they are not thinking of you. Wealthy lawmakers with fat retirement plans are clueless about asking retirees to pay extra when they have outpatient (Medicare Part B) expenditures.

Congressional members, both Republican and Democrat, are proposing $200 billion in cuts to Medicare. This is on top of the $735 billion in cuts to fund Obamacare subsidies for people under age 65.

If passed this will impact Medicare Advantage and Medigap plans alike.

UPDATE: Even more proposals under considerations HERE.

Medicare Money Grab – Part 2

 

Medicare changes hurt retirees

Under the guise of “bi-partisan” support Committee members are considering the following as a way to save Medicare.

Some of the cost would be offset with $35 billion worth of Medicare savings from beneficiaries over 10 years. Another $35 billion over a decade would come from reducing or delaying higher payments to hospitals and other Medicare service providers over time, the aides said. – Bloomberg

elderly womanJust what are these $35 billion in savings FROM beneficiaries?

You pay more for your health care. Medicare pays less.

Borrow from Peter to pay Paul.

The other Medicare changes are just as sinister.

Slow pay doctors and hospitals.

Not only does Congress want to pay doctors and hospitals less but they want to drag out payment for services rendered.

Yeah, that will work.

 

Georgia Medigap plans & Prices

Georgia Medigap plans & Prices

Changes to Medigap plans

That part where Congress wants YOU to pay more so they can spend less on your care?arm and a leg

They are drawing a bullseye on Medigap plans, in particular, Medicare supplement plan F.

The $35 billion worth of Medicare beneficiary savings would be achieved in two ways. Private insurance companies that offer so-called Medigap policies that supplement Medicare’s basic coverage would be required to start paying benefits only after recipients pay $250 in out-of-pocket expenses for doctor visits, aides said.

This is over and above the Medicare Part B deductible that is paid under Medigap plan F.

If you have plan G or N that would mean you are expected to pay the Part B deductible + an additional $250.

Other than the obvious, how does this save Medicare dollars?

Such a requirement would give Medicare recipients an incentive to make fewer doctor visits, thereby saving some costs to the government program.

If you have to pay more to see a doctor you might not go as often.

The folks in Congress must think we LIKE to go to the doctor.

Of course if their plan works, the less we go to the doctor the more likely we are to get sicker. The sicker we are the more it will cost to get us well.

Tell me again how these Medicare changes will save money?

 

What can we do?

Write and call our members of Congress. If you are a member of a senior lobbying group like AARP, AMAC, ASA or 60 Plus, contact them and tell them to stop this movement in its’ tracks.

We have paid into Social Security and Medicare all our working life. Congress has mismanaged both programs and now they expect us to pay for their sins.

One other thing you can do.

Even if we can’t stop this attempt to take money from retirees I can show you how to save at least $250 per year, and probably a lot more, by switching Medigap plans.

We have access to the lowest rates for popular plans F, G and N. Even if you bought coverage in the last 2 years many of those carriers are increasing rates.

Continental Life of TN is increasing rates on plan F by 9.5%.

Manhattan Life is increasing rates on ALL plans for those under the age of 68 by 9%.

If you own a Medicare supplement plan with either carrier now would be a good time to consider changing plans.

With over 170 different Medigap plans in Georgia you can most likely save money by changing.

Shop and compare GA Medigap quotes.

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What Does Medigap Plan N Cover?

What does Medigap plan N cover?

Medigap Plan N is a relatively new Medicare supplement plan that came into existence in 2010. It is now the 3rd most popular plan in Georgia behind plans F and G. happy couple

Medigap plan F is oversold for many reasons, not the least of which is the high premium and corresponding high commission. Many Medigap brokers take the easy way out and simply try to compete on price for plan F without ever explaining the value of plans G and N.

Simply stated, Medigap plan N covers 100% of your approved Medicare Part A hospital expenses in the same was as plans F and G. Approved Medicare Part B charges have cost sharing under plan N.

When you have the N plan you are responsible for office visit copay’s up to $20, ER copay’s up to $50 and any excess charges incurred when you use a provider that does not take Medicare assignment.

httpv://www.youtube.com/watch?v=2wZbLoBKceM

 

Does Medigap plan N include out of country coverage?

eiffel towerOnly Medicare supplement plans F and G include some coverage when you travel outside the United States.

For the most part, original Medicare does not cover out of country charges. Exceptions would be if you had a medical emergency while in a neighboring country like Canada or Mexico and it was not reasonable to travel to the U.S. for treatment.

Medigap plans C, D, F, G and N will pay 80% of emergency medical expenses after a $250 deductible. Refer to Medicare publication 11037 for more details.

Anytime you travel out of the country you should always consider purchasing a travel medical plan as offered by HCC.

hcc

 

 

What are Medicare excess charges?

Excess charges occur when a Medicare beneficiary uses a provider that does not accept Medicare assignment. Since 96% of providers DO accept assignment it is not an issue that will come up with any frequency.

If you do decide to use a provider that does not take assignment, be aware when you have Medigap plan N you are responsible for any balance billing by the provider once Medicare has approved your claim.medicare excess charges

Excess charges are capped by Medicare. The calculation works like this.

If the Medicare approved amount for a Part B expense is $100 (and you have satisfied your Part B annual deductible), Medicare will pay you 80% of 95% of the Medicare approved claim. The claim is initially reduced by 5% for a non-par provider which means the MAC (Medicare approved claim) is now $95. Medicare pays you 80% of $95 or $76.

Your Medigap plan N will pay you 20% of the 95% or $19.

Your doctor is allowed to bill you 15% in excess of the $95 MAC.

At this point you have received $76 from Medicare, $19 from your Medigap plan N carrier. The claim is capped at $109.25 which is referred to as the limiting charge.

In this case you will owe the doctor $14.25 out of your pocket.

Your doctor is required to submit your bill to Medicare and must wait until Medicare has adjudicated the claim and you have received payment from Medicare and your supplement carrier before they can bill you.

 

Why pick Medicare supplement plan N?

SenCitFor many people it is a cost effective alternative to most Medicare Advantage plans. Medicare Advantage plans have doctor and hospital networks that may be inconvenient for you, the patient. The cost sharing under Medicare Advantage plans can be significant, as much as $6700 in 2018 and that is just for IN network approved charges. Your out of network charges are in addition and may not be capped at all.

It is rare for a Medicare beneficiary with plan N to have out of pocket expenses that exceed $500 per year and with most people your out of pocket is considerably less.

Medigap plan N offers more value than plans F or G for most people but it is not for everyone. If you have a chronic condition that requires multiple doctor visits over the course of a year, plan N may not be the best plan for you.

I  turned 65 in September of 2015 and chose Medicare supplement plan N for myself. Next April when my wife goes on Medicare she will probably pick the same plan.

How much can you save with plan N?

Shop and compare GA Medigap quotes.

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