Countdown to Medicare with Type 1 Diabetes: 11 Months / Options for Testing Supplies

Laddie_Head Square11 months from now I will be on Medicare. April 2017. My aim is to write a monthly blogpost about what I am learning as I get closer to that date. Last month I wrote a general overview of my Medicare thoughts. This month I want to talk about testing supplies and Medicare’s national mail-order program for diabetes testing supplies.

Background:  In July 2013 Medicare instituted a national mail-order program for diabetes testing supplies that requires all beneficiaries to use a Medicare-contracted supplier for home-delivery of testing supplies. (Note: this applies to original Medicare only and not to Advantage plans. Also note that it is possible to buy testing supplies locally instead of through the mail-order program.) Part of the Competitive Bidding Program (CBP), this program was launched in nine test markets in 2011. According to a 2012 Centers for Medicare & Medicaid Services (CMS) update report:

 “CMS real-time claims monitoring has found no disruption in access to needed supplies for Medicare beneficiaries. Moreover, there have been no negative health care consequences to beneficiaries as a result of competitive bidding.”

The Government Accountability Office (GAO) challenged the safety monitoring methods used by CMS and questioned whether beneficiaries were receiving supplies on time and whether adverse health outcomes were resulting from problems accessing testing supplies. Adding to the GAO analysis, the National Minority Quality Forum worked with leading endocrinologists to analyze the data and released an online report in March, 2016 followed by a print article in Diabetes Care, the professional journal of the American Diabetes Association. This analysis indicated that:

“the Competitive Bidding Program disrupted beneficiaries’ ability to access diabetes testing supplies, and this disruption was associated with an increase in mortality, higher hospitalization rates and inpatient costs.”

This article received a lot of attention in the diabetes online community and prompted an initiative by DPAC (Diabetes Patient Advocacy Coalition) urging Americans to contact their elected representatives to #SuspendBidding. Click here to learn more about DPAC’s analysis of the problem and to contact your representatives.

My Perspective:  Rather than stress about my ability to get high-quality testing supplies once I get to Medicare, I decided to contact some experts: people I know with Type 1 diabetes who are on Medicare. I communicated with eleven seniors by email, phone, and/or in person. Some live in Minnesota and others in Arizona.

In general each T1 senior is getting diabetes testing supplies on a timely basis and is able to get their brand-of-choice. Several people buy test strips at local Medicare-approved pharmacies while others purchase them through mail-order Medicare suppliers. Although their Medicare experiences are not without occasional glitches, most of my contacts are satisfied with their ability to obtain testing supplies through Medicare.

Some of the comments I received are:

“It is not as fretful as you may think although some resources are better than others. Type 2’s have a harder time. At the beginning of your Medicare enrollment there may be some stumbling blocks until the required documentation is submitted appropriately by each member of your health care team”

“I am getting all the supplies I need of my choice, excluding CGM.”

“Once I couldn’t get the test strips I use, but it was a temporary thing. They were not able to get them from the supplier…. I get my supplies in a timely matter.”

“I have been on Medicare (with a supplement) for the last 8 years. I haven’t had any trouble with getting pump supplies or strips. My doctor is very cooperative and prescribes what I need.”

“I have never had a problem getting my test strips.”

But all is not perfect. One friend was recently forced to change strip brands, but she was able to select another “name-brand” meter and strip. Another friend has continued to work past age 65 in order to continue receiving CGM coverage.

A few more comments:

“They limit me to 5/day because that’s all I have shown on my logs…. I don’t think my endo has been any help at all.”

“I haven’t had any trouble with Medicare, but I have read about many others who have had trouble.”

“I find the whole medical insurance business so confusing. I have stacks of documents that come in the mail that make no sense.”

Summary:  I am encouraged by the feedback I received from my Medicare T1 friends. At the same time I know that these seniors are a unique subset of Medicare beneficiaries with Type 1 diabetes. They are empowered, well-educated, and reasonably financially-secure. Many of them have had Type 1 for more than 50 years and are used to navigating the US healthcare system to fight for what they need.

I plan to enter Medicare with a stockpile of testing supplies and know that I will need to get my ducks in a row to have the transition go smoothly. I need to remember that there will be bumps in the road along with a definite learning curve. I understand that new rounds of competitive bidding will continue to take place and just because things are fine today doesn’t mean that they will be fine tomorrow.

If you are on Medicare, I’d be interested in hearing about your experiences obtaining testing supplies and any advice you might have navigating Medicare. I have a lot to learn for sure.

5 thoughts on “Countdown to Medicare with Type 1 Diabetes: 11 Months / Options for Testing Supplies

  1. Laddie, as you know Medicare is my primary and BCBS secondary insurance. So far I have had two experiences with the Medicare competitive bidding process. I was previously using Bryam Heathcare for my mail order Freestyle test strips. When I went on Medicare Byram had not won the bid and could no longer supply my pre Medicare generous 90 day supply. I now get my test strips every month from my local CVS, and thanks to my Dexcom I have plenty of test strips. Experience number two: when I called in my reorder for Cpap supplies, I was told that since the company had not won the bid, they would not be able to fill my order and suggested a company that had won the bid. I successfully ordered from that company. So I would say that I have not suffered from these two minor changes.

    • Thanks, Sue, and glad to know everything worked out for you. Flexibility is the name of the game for sure. Nice to hear from you:-)

  2. Laddie, as you mentioned above, Advantage Plans are not part of the competitive bidding process. Don’t be afraid of an Advantage Plan. A local insurance company in my area offers an HMO and a PPO Advantage plan, one of which I have been in for six years. They allow for name-brand test strips, over quantity in my case as I produce a log for one month every year. They also cover Dexcom and Omnipod, both of which regular Medicare does not cover. When I went into Medicare, all doctors I saw were in this Advantage Plan, so I had no changing of doctors. Don’t be afraid to check out every plan available to you when you enter into Medicare. The plan I have is only available to people living in the metropolitan area of Detroit.

  3. Thanks for sharing your experience, Judi. So far I have gotten mixed advice on Advnatage plans, but I think it depends on where you live and what coverage you need. It sounds as though you are getting great coverage and I know someone in Minnesota on an Advantage plan who is getting CGM coverage. So it’s definitely something to consider.

  4. I would also say I have had success with Medicare and test strips. Since I get my strips at CVs, it is a breeze and a cost saving over my prior methods.

    I referred your blog to the TUDiabetes blog page for the week of May 2, 2016.

Comments are closed.