Topic: Financial Help for Diabetes Care
Question: What is (are) Financial Help for Diabetes Care ?
Answer: Medicare is a federal health insurance program that pays health care costs for eligible people who are
                
- age 65 or older  - under age 65 with certain disabilities  - of any age with end-stage renal diseasetotal and permanent kidney failure that requires a kidney transplant or blood-filtering treatments called dialysis
                
What health plans does Medicare offer?
                
Medicare has four parts:
                
- Part A (hospital insurance) covers inpatient care, skilled nursing home residence, hospice care, and home health care. Part A has no premium for those who have paid enough Medicare taxes. A premium is an amount a person must pay periodicallymonthly or quarterlyfor Medicare, other health plan, or drug plan coverage. Part A does have a deductible, an amount a person must pay for health care or prescriptions before the health plan will pay. A person must pay a daily amount for hospital stays that last longer than 60 days.  - Part B (medical insurance) covers services from health care providers, outpatient care, home health care, durable medical equipment, and some preventative services. Part B has a monthly premium based on a persons income. Rates change each year. After a person pays the deductible each year, Part B pays 80 percent for most covered services as a primary payer. The billing staff of the service providerhospital or cliniccan calculate how much a person will owe.  - Part C (Medicare Advantage Plans) are part of Medicare and are sometimes called MA Plans. Medicare must approve Medicare Advantage Plans. Each Medicare Advantage Plan must cover Part A and Part B services and may cover other services, too. Medicare Advantage Plans may have Part D prescription coverage. If not, a person can buy a Part D plan separately. Medicare Advantage Plans are not all the same. A person who is thinking of choosing a Medicare Advantage Plan should ask about the rules of the plan. The rules may specify which health care providers or hospitals a person may use. The plan may require a referral from a primary care provider to see a specialist. The plan may not cover medical expenses incurred during travel. How much a person has to pay out-of-pocket each year will vary by plan. People who have a Medicare Advantage Plan cannot have a Medigap plan to help pay out of-pocket costs. See the section on Medigap.  Four types of Medicare Advantage Plans are available:      - HMOs    - preferred provider organizations (PPOs)    - private fee for service plans    - special needs plans for certain groups    - Part D (prescription drug coverage) has a premium and covers some medications. Private insurance companies offer different Part D plans approved by Medicare. Costs and coverage vary by plan. A person who has few assets and earns less than 150 percent of the federal poverty level may qualify for extra help to pay Part D premiums and medication costs. People can apply for this help by calling the Social Security Administration, visiting www.socialsecurity.gov to apply online, visiting their local Social Security office, or contacting their state medical assistance (Medicaid) office. People can find the current-year guidelines at www.aspe.hhs.gov/poverty or by calling Social Security at 18007721213, TTY 18003250778. People can find information and applications for Part D plans at www.medicare.gov. A person can also apply for Part D with an insurance company that sells one of these plans.
                
Other Medicare health plans are for certain groups, such as frail people living in the community and people with multiple chronic illnesses, and include hospital and medical coverage. Some pay for prescribed medications, too. State health insurance programscalled Medicaidpartially finance and administer these services. The plans include the following:
                
- Medicare Cost Plans are HMOs, like the ones offered as Medicare Advantage plans, only out-of-network providers are paid as if the policyholder had Original Medicare. Original Medicare is Medicare Part A and Part B.  - Program of All-Inclusive Care for the Elderly (PACE) combines medical, social, and long-term care services for frail people who live and get health care in the community.  - Medicare Innovation Projects are special projects that test improvements in Medicare coverage, payment, and quality of care.
                
Read more about Medicare Cost Plans and Demonstration or Pilot Programs on the state Medicaid website at www.medicaid.gov or call 1800MEDICARE (18006334227). State Medicaid offices can provide more information about PACE. See the section on Medicaid.
                
Does Medicare cover diabetes services and supplies?
                
Medicare helps pay for the diabetes services, supplies, and equipment listed below and for some preventive services for people who are at risk for diabetes. However, coinsurance or deductibles may apply. A person must have Medicare Part B or Medicare Part D to receive these covered services and supplies.
                
Medicare Part B helps pay for
                
- diabetes screening tests for people at risk of developing diabetes  - diabetes self-management training  - diabetes supplies such as glucose monitors, test strips, and lancets  - insulin pumps and insulin if used with an insulin pump  - counseling to help people who are obese lose weight  - flu and pneumonia shots  - foot exams and treatment for people with diabetes  - eye exams to check for glaucoma and diabetic retinopathy  - medical nutrition therapy services for people with diabetes or kidney disease, when referred by a health care provider  - therapeutic shoes or inserts, in some cases
                
Medicare Part D helps pay for
                
- diabetes medications  - insulin, excluding insulin used with an insulin pump  - diabetes supplies such as needles and syringes for injecting insulin
                
People who are in a Medicare Advantage Plan or other Medicare health plan should check their plans membership materials and call for details about how the plan provides the diabetes services, supplies, and medications covered by Medicare.
                
Read more at www.medicare.gov/publications/pubs/pdf/11022.pdf (PDF, 1,023 KB) or call 1800MEDICARE (18006334227) to request the free booklet Medicares Coverage of Diabetes Supplies & Services.
                
Where can a person find more information about Medicare?
                
A person can find more information about Medicare by
                
- visiting the Medicare website  - calling 1800MEDICARE
                
Medicare website. Read more about Medicare at www.medicare.gov, the official U.S. Government website for people with Medicare. The website has a full range of information about Medicare, including free publications such as Medicare & You, which is the official Government handbook about Medicare, and Medicare BasicsA Guide for Families and Friends of People with Medicare.
                
Through the Medicare website, people can also
                
- find out if they are eligible for Medicare and when they can enroll  - learn about their Medicare health plan options  - find out what Medicare covers  - find a Medicare Prescription Drug Plan  - compare Medicare health plan options in their area  - find a health care provider who participates in Medicare  - get information about the quality of care provided by hospitals, home health agencies, and dialysis facilities
                
Calling Medicare. Calling 1800MEDICARE (18006334227) is another way to get help with Medicare questions, order free publications, and more. Help is available 24 hours a day, every day, and is available in English, Spanish, and other languages. TTY users should call 18774862048.
                
Access Personal Medicare Information   People who enroll in Medicare can register with www.MyMedicare.gov, a secure online service, and use the site to access their personal Medicare information at any time. People can view their claims and order history, and see a description of covered preventive services.
                

                
What is Medigap?
                
A Medigap plan, also known as a Medicare supplement plan, can help pay what Original Medicare does not pay for covered services. Insurance companies sell Medigap coverage. People who have a Medicare Advantage plan cannot also have a Medigap plan. A person can buy a Medigap policy from any insurance company licensed to sell the policy in the persons home state.
                
For people who are 65 and older, federal law says that in the first 6 months a person has Part B, companies cannot deny an application or limit payment for anything Original Medicare covers. Some states make insurance companies sell at least one Medigap coverage plan to those under 65 with Medicare. State insurance offices can explain the plans in their state. Find local offices on a map at www.naic.org/state_web_map.htm .
(Source: NIDDK)