Insulin pumps: Medicare coverage?By Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/insulin-pumps/MY01893
- With Mayo Clinic diabetes educators
Nancy Klobassa Davidson, R.N., and Peggy Moreland, R.N.read biographyclose window
Nancy Klobassa Davidson, R.N., and Peggy Moreland, R.N.Nancy Klobassa Davidson and Peggy Moreland
Nancy Klobassa Davidson, R.N., B.S.N, C.D.E
Nancy Klobassa Davidson is a registered nurse who has worked in diabetes education for 17 years. She is a certified diabetes educator (C.D.E.) and is currently in graduate school working on a Master of Science in nursing (M.S.N.) and health care education.
Nancy works with adults who have type 1, type 2 and other forms of diabetes. Nancy is coordinator of the Diabetes Unit's intensive insulin therapy program within the Division of Endocrinology, Diabetes, Metabolism, & Nutrition at Mayo Clinic in Rochester, Minn. Nancy has worked extensively with insulin pump therapy and continuous interstitial glucose sensing.
Peggy Moreland, R.N., M.S.N.
Peggy Moreland is a certified diabetes educator (C.D.E.) in the Division of Endocrinology, Diabetes, Metabolism, & Nutrition at Mayo Clinic in Rochester, Minn.
Peggy graduated with a Master of Science in Nursing and Health Care Education from the University of Phoenix and is a member of the American Association of Diabetes Educators and the American Diabetes Association. A certified diabetes educator (C.D.E.), Peggy enjoys working with patients to set and achieve diabetes self-management goals.
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Insulin pumps: Medicare coverage?
By Nancy Klobassa Davidson, R.N., and Peggy Moreland, R.N.
This blog is the third in a three-part series in which we discuss Medicare coverage for diabetes supplies.
Medicare Part B covers insulin pumps worn outside the body — including the insulin used with the pump — for some people with Medicare Part B who have diabetes and meet certain conditions.
What are those conditions? You must meet either criteria A or B.
Criteria A states that you must:
- Meet C- peptide or beta cell autoantibody lab test results requirement (blood test results that show that you make little or none of your own body insulin)
- Complete a comprehensive diabetes education program
- Have been on a multiple daily injection (MDI) program for six months, using at least three insulin injections a day
- Provide documentation of blood glucose testing an average of four times per day
- Meet one of the following: 1. Have an A1C greater than 7 percent, 2. Have a history of recurring hypoglycemia, 3. Experience wide fluctuations in blood glucose levels before meals or dawn phenomenon — an early morning rise in blood glucose or hormone levels
- Experience severe swings in blood glucose levels
Criteria B states that you must have been using an insulin pump prior to enrollment in Medicare, and that you have documentation of testing your blood glucose four times a day during the month prior to Medicare enrollment.
In addition, it's important to note:
- Coverage amount. If approved, you pay 20 percent of the Medicare approved amount after the yearly Part B deductible.
- Provider requirements. The insulin pump must be ordered by a medical provider who manages multiple patients on insulin pumps, and you must be seen by this provider every three months.
- Timing of prescription renewal. Before your yearly prescription has run out, you must be seen by your insulin pump provider in order for Medicare to continue paying for pump supplies. I have seen cases in which my patients didn't have an appointment with their provider, or the appointment got delayed or missed. Medicare wouldn't cover the supplies until that individual was seen by the provider. Meanwhile, the patient was stuck without supplies and was unable to use his or her insulin pump.
What are your experiences with insulin pumps and Medicare?
Have a good week.