Medicare's National Mail-Order Program for Diabetes Testing Supplies
(Part of the Medicare Competitive Bidding Program)
Beginning on July 1, 2013, a Medicare National Mail-Order Program for diabetes testing supplies goes into effect. The mail-order diabetes supplies included in the National Mail-Order Program are: blood glucose test strips, lancets, lancet devices, batteries and control solution. Beneficiaries who want their diabetes testing supplies delivered to their home must use a Medicare national mail-order contract supplier. Beneficiaries also have the option to pick up their testing supplies from a local store (local pharmacies or storefront suppliers) enrolled in Medicare.
Does this apply to me?
This impacts Medicare beneficiaries in all 50 states, D.C., Puerto Rico, the U.S. Virgin Islands, Guam, and American Samoa, who have Original Medicare. These changes do not apply to Medicare Advantage plans (like an HMO or PPO). If you are enrolled in a private plan through Medicare, you can contact your plan to find out which suppliers you can use.
Where can I get diabetes testing supplies starting July 1, 2013?
If this applies to you and you want diabetes testing supplies delivered to your home, you must use an approved Medicare national mail-order contract supplier in order for Medicare to help pay for the supplies. To find a contract supplier, call 1-800-MEDICARE (800-633-4227) or visit www.medicare.gov/supplier.
Alternatively, Medicare will still cover your diabetes testing supplies if you buy them at a local Medicare-enrolled pharmacy or other store.
TIP: If you buy supplies at a pharmacy or other store, be sure to ask if the store accepts "Medicare assignment!" This means the store will accept the Medicare-approved amount as payment in full, and you cannot be charged more than 20% coinsurance (after you meet your deductible). If a local store does not accept Medicare assignment, you may be charged more than the 20% coinsurance. Be sure to check with the store to find out what your payment will be.
What will I pay for diabetes testing supplies?
After you have paid your annual Medicare Part B deductible, Medicare pays 80% of the Medicare-approved payment amount for supplies and you are responsible for 20% of the cost (called a 20% coinsurance). The coinsurance may be covered by supplemental insurance, such as a Medigap plan, if you have such coverage. Medicare’s approved payment amount will be the same whether you buy your diabetes testing supplies at a local store or have them delivered to your home. National mail-order contract suppliers and local stores that accept assignment can’t charge you more than 20% coinsurance. Note: You may pay more if you get your supplies from a local store that does not accept assignment.
I like the blood glucose monitor and testing supplies I currently use. Can a mail-order contract supplier switch me to a different brand?
No. Mail-order contract suppliers are not allowed to influence you or give you an incentive to switch to a different brand of glucose monitor and testing supplies.
The National Mail-Order Program for diabetes testing supplies does not require that you change your glucose testing monitor. Mail-order contract suppliers must provide the brand of testing supplies that works with your monitor. If the contract supplier does not carry your brand of supplies, you can ask them about other brands, but the supplier cannot give you information about different brands unless you ask.
TIP: If you are satisfied with your current monitor, you may need to shop around to find a mail-order contract supplier or a local store that can provide you with the supplies you need. To find a Medicare supplier in your area, call 1-800-MEDICARE (800-633-4227) or visit www.medicare.gov/supplier.
The National Mail-Order Program also contains a protection to help beneficiaries get the specific supplies they need when they are medically required. Your doctor must prescribe the specific item or brand of supplies in writing, and note in your medical record that you need this specific item or supply to avoid an adverse medical outcome. If your doctor does that, then a Medicare contract supplier must:
- Give you the exact brand you need;
- Help you find another contract supplier that has that brand; or
- Work with your doctor to find an alternative brand for you and get a revised written prescription from your doctor.
For More Information
- To find a Medicare supplier in your area and for more information, call 1-800-MEDICARE (800-633-4227) or visit www.medicare.gov/supplier.
- Free health insurance counseling and personalized assistance for Medicare beneficiaries is available in every state through the State Health Insurance Assistance Program (SHIP). Call 1-800-MEDICARE (800-633-4227) to find the telephone number of the SHIP office closest to you.
Beware of Fraud: Medicare has rules to protect you from unsolicited phone calls from suppliers. If you get calls from suppliers you've never used before asking you to switch suppliers or if you get items in the mail you did not order, you can call the Fraud Hotline at the HHS Office of Inspector General at 1-800-HHS-TIPS (800-447-8477).