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I can't seem to find out if anyone pays for her diabetic supplies. Each part of Medicare tells me another part is responsible for it. The pharmacy has all of her insurance profile on file, and I end up paying out of pocket for her insulin pen needles. Each part of Medicare tells me another part is responsible. So far it seems like I am the only one responsible.

The coverage is complex, as others have noted. This site gives detailed current information that comes from Medicare. You'll see why you keep being referred from one place to another. Too often the answer is, "It depends. . . ."

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE18011.pdf
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Reply to caroli1
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For those seeking help paying for Prescriptions Medications have you researched NeedyMeds.org
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Reply to MedicareMan
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Just in case anyone isn't aware of it. Medicare has added an additional time period for people with Medicare Advantage plan to make a change to a different plan if they don't like their current plan. It will be Jan.1 - March 31.
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Reply to Nancynurse
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Go to medicare.gov online and the first page scroll down to "doctors, provider, hospitals plans and supplies". Go on down that list to "Find suppliers of Medical equipment and supplies". You must use a certified supplier for all diabetic testing supplies and depending on insurance they will be provided at little or no cost. As for the needles you should go through her Part D plan. Some plans cover some of the cost and some do not. I would suggest that you check with your local SHIP office located at the Office for Aging and they can help you sort this out. If her current plan isn't covering her properly they may be able to find a plan that will. There are several to chose from. This information is for a supplemental and a Part D plan. If she has an Advantage plan that includes Part D and her medical, then they should handle it all. It really can get confusing. Again I recommend finding a SHIP counselor.
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Reply to Nancynurse
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I think that will depend on which Medicare Supplement Plan letter you have.
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Reply to Llamalover47
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Your Mothers Medicare Part B pays for Diabetic Supplies. If she has a Medigap Insurance policy Plan F she shouldn't pay anything out of pocket. If she has plan G and hasn't yet met her Part B deductible she’ll need to meet that then her supplies would be covered. If your mother is not on original Medicare and is in a Medicare Advantage Plan then her Advantage plan benefits apply.
I hope this helps. If not and if you're still confused and needing help feel free to contact me. Good luck.
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Reply to MedicareMan
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DMMednick1957 Dec 4, 2018
I don’t think this answer is very clear. There are certain things under Part B (like test strips) but others under Part D if they have a Medicare Advantage. There are 4 diabetic supplies covered under Part D. The remainder is Part B.
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If she had an Advantage Plan, it gets complicated. Ask doctor to order needles in bulk. I take B-12 injections... longer needle...and 1 costs 90% of cost of a dozen. When I took weekly, cost more for 1-4 needles than to get 50!.

It use to be many places, like Walgreens, would not give you a with insurance price in an RX unless they had written RX in their hand and ran it through as if filing it. Then you had to have them reverse the process to go to the next place.
This craziness must have angered the wrong Congressman or donor, because they made a law. All the pharmacy chains had to change their system, so you can get Your price, over the phone!
Also, if you enter the Medicare Part D website, just enter the diabetic supplies for your LO. You will have to play around with Pharmacy choices...they only look at 2or 3 at a time last I looked. If you scroll down and expand, it will give you actually cost by month.

Find best few plans then add the rest of the drugs, and recheck. Good news is you can do this from home, very early or late is best. Internet & site less bogged down.

Who ever thought having to get online and research this stuff during Black Friday - Cyber Monday...Cyber Holiday week is a fool!!! Note: Does LO need to use a particular brand? Many fomualries will cover only one brand of drugs commonly needed by SRs.
Example: Osteoporosis RX...I leave it off the list to check plans, or start with just brand A, then change to Brand B, this is where a printer, highlighter, and expanded printout really help. Almost No Plans covered both brands. For this drug alternating brands from time to time is good.
Also some Rx are only on most expensive plans, but since I Must take expensive brand due to interactions or other medical conditions, I get Dr. to write Exception to Formulary! If there is valid medical reason, plans will approve. If it fails first time, work with Dr to make sure medical necessity is clear....or the RN who actually drafts the notes!
If income is tight you can then/also ask for exception to Tier, making Tier 4 or 5 drug drop to lowest cost. ( Hope she is not as broke as me!)
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Reply to GraceLPC
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Insulin pen needles are about $400 to $700 a month just for the delivery system, so there may be issues about the pen with her insurance. Getting insulin bottles and needles are much cheaper (although insulin is hardly cheap). Learn to draw them up yourself.
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Reply to cetude
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Hello, my Mom received a referral from her Doctor to EMedical. She gets her needles and strips free-mailed directly to the house. Mom is covered via HealthNet/Medicare Seniority Plus(?). She is in California. I would speak with your Mom's PMC Doctor about options
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Reply to ggkekegirl7
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An insurance agent spoke with my Mom & I on how she would be better served by switching to a "Dual Silver Plan " because she is also diabetic & has Medicare & medicaide. On the dual plan she has no copay for anything . No copay for Dr. visits , hospital stays, E.R. visits, ambulatory transports, medicines etcetera. Although the pharmacy had a time trying to get her test strips to go through. The agent tried everything , even a three way call between myself, insurance rep and he , while the pharmacist listened to the whole thing on speaker. We finally ended up getting her test strips, prep pads , pen tips & meter through the mail all from one company after her doctor filled out paper work (presciption) & faxed it to them
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Reply to ken1938
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I would think if its part D the pharmacist should be able to tell u what Medicare pays. If ur supplimental has express scripts it maybe the cheapest way to go. When you get this straightened out, I would ask how you can get reimbursed for prior purchases.
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Reply to JoAnn29
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There are co-pays on all of my diabetic supplies under Part D drug coverage. With co-pays. I pay a total of about $140.00 in co-pays for insulin, needles and test strips. I have Express Scripts for my Part D coverage.
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Reply to UsedupDIL
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46.00 seems like a lot for those needles, I would do some shopping around. You can also ask how much without insurance. I paid 9.00 per 100 for my dogs allergy needles, which were the tiny ones used for insulin at Costco Pharmacy.

My dad paid alot for his scripts on a Medicare Advantage plan. Now he pays very little, we do shop for the best negotiated price, not all are the same, ie 20 at CVS and 25 at Walgreens. Doesn't make any sense but it is a reality.
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Reply to Isthisrealyreal
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jacobsonbob Dec 4, 2018
There's a company named "Blink" that may be able to get you some discounts. I use eye drops that I get from Canadian companies (in my case actually shipped from the UK); this saves me a great deal, but I assume this would be impractical for insulin and some other items.
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I found out that part D is in fact responsible however they don't contribute to what they call the "copayment." They claim they negotiated the pharmacy price from 53.00 for a box of 100 needles to 46.00. I pay the full 46 dollars. This is Value Plus through Aetna. Anyone else have any experience like this?
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Reply to salutem
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You need to read the policy You will find it in D. My mom has co pays for the needles and a portion if the insulin. Just like other drugs, I find that the copay on insulin is 40% less between 2 pharmacy providers. You could shop around.
Find her insurance card to determine her plan. She should have received a book prior to open enrollment for her to compare plans. She is now at the deadline for open enrollment.
There are other ways to compare drug prices...online Medicare, or contact your state if they have a booklet.
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Reply to MACinCT
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If you can find a copy of the "Medicare and you" hands books for 2018 and 2019 they explain this pretty good. And what supplies may be paid for and the co-pays associated with them.
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Reply to OldSailor
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jacobsonbob Dec 4, 2018
Is it available online?
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