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Frequently Asked Questions |
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Do I need to apply for Medicare when I turn 65? |
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No. If you are already getting Social Security or Railroad Retirement benefit payments, when you turn 65 you will automatically receive a Medicare card in the mail about three months before your 65th birthday as part of an enrollment information package. The card will usually show that you are entitled to both Part A (Hospital Insurance) and Part B (Supplementary Medical Services) and indicates the beginning dates of your entitlement to each. If you do not want Part B, follow the instructions that come in the package. |
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Who can receive benefits for diabetes testing supplies and receive diabetes self-management training? |
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All Medicare beneficiaries with diabetes (insulin treated and non-insulin treated) can receive coverage for diabetes testing supplies. Individuals covered by Medicare who are at risk for diabetes-related complications and meet other requirements can receive training if it is requested by the doctor or other provider. |
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How do I know my diabetes supplies are covered by Medicare?
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If you receive glucose a monitor from a supplier without asking for them, Medicare will not pay the cost. Medicare requires you or your caregiver to specifically authorize a refill of your supplies (such as testing strips, lancets or control solution) before they are sent to you. You should not pay for supplies you did not authorize.
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How much is reimbursed for each product?
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After the patient has paid their annual Medicare Part B deductible, Medicare will reimburse 80% of the Medicare Allowed Amount or 80% of the retail price of the product (whichever is lower). |
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Does everyone pay the same amount for the Part B premium?
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There is always a premium payment for the Medicare Part B coverage. The premium is usually paid by the individual, either through deductions from Social Security checks or direct billing. The state you reside in may pay Medicare premiums if your income is low. However, most people pay the same premium amount. |
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Are there limits on the number of supplies that will be reimbursed? |
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Medicare establishes certain limits based on whether or not you use insulin injections to treat your diabetes. Your physician will indicate how often you should test. Medicare may approve additional testing supplies if your physician determines it is necessary. |
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When will Medicare cover additional test strips and lancets?
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- If the patient's physician has seen the patient within the last 6 months and has evaluated their diabetes control.
- When the physician has documented in the patient’s medical record the specific reason for the additional strips and lancets for that particular patient.
- When the patient keeps a testing log book in their medical records or otherwise documents the frequency at which the patient is actually testing. The patient must provide the supplier with a copy of one month of test readings every six months.
- When the patient's physician provides a written order for the frequency of testing that is greater than established utilization limits.
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How do I replace my Medicare card and where do I call to change my address?
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Please call the Social Security Administration (SSA) at 1-800-772-1213. A representative can request that a replacement Medicare card be sent to you. The best time to call is Tuesday through Friday between 7 a.m. and 7 p.m. Make sure you have your Medicare number handy. You should receive the replacement card in four weeks.
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If I'm ready to retire and my employer is going to provide me with benefits, do I need Medicare? I'm age 65 and ready to retire.
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Yes. Medicare pays first in all situations unless you (or your spouse) are eligible under an employer sponsored group health plan. If you have other insurance and have questions about who pays first, call the Coordination of Benefits Contractor at 1-800-999-1118.
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Does Medicare cover my spouse and family?
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In general, Medicare is “individual” insurance. However, sometimes spouses and children can become eligible for Medicare based on the wage earner's work record. Contact the Social Security Administration at 1-800-772-1213 for questions about Medicare eligibility.
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What is the difference between Medicare and Medicaid?
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Medicare: Medicare is an insurance program. People have paid into trust funds which cover medical bills. It primarily covers people over 65 regardless of their income. It also serves younger disabled people and dialysis patients. Patients pay part of costs through deductibles for hospital and other costs. Small monthly premiums are required for non-hospital coverage. Medicare is a federal program. It is run by the Centers for Medicare and Medicaid Services (CMS), an agency of the federal government, and is basically the same everywhere in the United States.
Medicaid: Medicaid is an assistance program. It serves low-income people of various ages. Medical bills are paid from federal, state and local tax funds. Patients usually pay no part of the costs or very little for covered medical expenses, although a small co-payment is sometimes required. Medicaid is a federal-state program. It is run by state and local governments within federal guidelines, so it varies from state to state. |
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Where should I send my Medicare Premium payment? |
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Medicare Premium Collection Center
Post Office Box 371384M
Pittsburgh, PA 15250
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Who can I contact for more information about Medicare eligibility?
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Please contact the Social Security Administration at 1-800-772-1213
or go to www.medicare.gov. |
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