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    November 7, 2013      

 

Medicare Benefits at a Glance
Medicare Part A
Medicare Part B
Medicare Part D
Medicare Publications

 

 

Medicare

When you have Medicare as the primary payer and the NALC Health Benefit Plan, charges for services and supplies covered by Medicare are paid in full between Medicare and the Plan. When Medicare applies the calendar year deductible and coinsurance to services payable by Part A or Part B, the Plan pays 100% of the balance resulting in no out-of-pocket costs to you!

When Medicare is primary payer and covers the charges you are not required to:

  • Precertify a hospital confinement
  • File a claim for covered charges

Medicare Part B and Diabetic Supplies

Medicare covers blood glucose self-testing equipment and supplies 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; and
  • Glucose control solutions for checking the accuracy of testing equipment and test strips.

Because Medicare Part B covers diabetic supplies, charges for the supplies are not eligible to be purchased using the Plan's CVS/Caremark prescription benefit when Medicare Part B is primary.  Benefits will be denied at both retail and mail order, and when a paper claim is filed for reimbursement.

If you have primary Medicare Part B coverage and need diabetic supplies, you will need to obtain a prescription from your physician that includes the following information:

  • Script must state the patient has diabetes;
  • What kind of blood glucose monitor they need and why they need it (i.e., if they need a special monitor because of vision problems, their doctor must explain that);
  • Whether they use insulin; and
  • How often they should test their blood glucose.

(If you change medical suppliers, the new/current supplier will require the above information, even if on file with a previous supplier.)

Present your Medicare Identification card, as well as your NALC HBP Identification card, at any Medicare-enrolled pharmacy or supplier.  The provider will automatically bill the Medicare Durable Medical Equipment (DMERC) carrier and the claim will cross electronically to us as a medical claim through the Medicare Crossover Program.

All Medicare-enrolled pharmacies and suppliers must submit claims to Medicare for blood glucose monitor test strips.  A beneficiary cannot submit a claim for blood glucose monitor test strips themselves.

For more information, visit the cms website.

 

*Medicare will not pay for any supplies not asked for, any supplies that were sent to a beneficiary automatically from suppliers or for any supplies from non-enrolled pharmacies or non-enrolled suppliers.