Coverage of diabetes supplies split on Medicare plans; Covering; The Bases

I am diabetic. I have Original Medicare, a Medigap and a Part D drug plan. I am confused as to what covers my insulin and syringes, and what covers my test strips/lancets to test my blood sugar.

This question is very common.

Medicare Part B (your red, white and blue card) covers your test strips and lancets that you use to test your blood sugar. Medicare Part B will pay 80 percent of the Medicare-approved amount for these items. Your Medigap plan would cover the remaining 20 percent. The insulin and syringes you use to inject your insulin are covered under your Medicare Part D drug plan.

You may want call 1-800-MEDICARE, or visit www.medicare.gov, to obtain a copy of a booklet entitled, "Medicare Coverage of Diabetes Supplies and Services." This booklet provides more detail about Medicare benefits for people with diabetes.

I was hit hard with the viral upper respiratory infection that has been going around. I ended up on codeine cough suppressant since my incessant coughing was painful and kept me awake at night.

I couldn't believe that my Medicare Part D plan refused to pay for this necessary medicine. Luckily, I could afford the medicine. I am now sleeping better and I am on the mend.

I am sorry to hear about your recent illness and I am glad you are recovering.

Your experience, while unfortunate, is a result of the rules that govern Medicare Part D. By law, Medicare Part D excludes certain medicines. Some Medicare Part D plans will cover these medicines but only as a supplemental benefit. In such cases, any money paid for these medicines will not count towards your Medicare Part D "out-of-pocket" cost protections.

The Medicare publication, Medicare Drug Coverage under Medicare Part A, Part B, Part C and Part D (CMS Publication No. 11315-P), provides the following list of medicines excluded from the basic Medicare Part D coverage:

*Drugs when used for weight loss or gain

*Drugs when used for treatment of sexual or erectile dysfunction, unless these drugs are used to treat a condition other than sexual or erectile dysfunction, for which the drugs have been approved by the Food and Drug Administration

*Drugs when used for symptomatic relief of cough and colds

*Non-prescription drugs

*Drugs when used for cosmetic purposes or hair growth

*Drugs when used to promote fertility

*Prescription vitamins or minerals, except prenatal vitamins and fluoride preparation products

In addition to this above list, if a medicine would be covered under the Medicare Part A (hospital) benefit or the Medicare Part B (outpatient) benefit, then a Medicare Part D plan will not cover the medicine.

Amy Rubino is the director of the Senior Health Insurance Assistance Program and the Senior Medicare Patrol for the Anne Arundel County Department of Aging and Disabilities. You may contact either program at 410-222-4257 or [email protected].

Credit: Amy Rubino - Amy Rubino is the director of the Senior Health Insurance Assistance Program and the Senior Medicare Patrol for the Anne Arundel County Department of Aging and Disabilities. You may contact either program at 410-222-4257 or [email protected].