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Marci's Medicare Answers (online only)
February 2011
By Medicare Rights Center

Dear Marci,
I was recently diagnosed with diabetes, and my doctor says I will need training to learn how to manage this disease. Is the training covered by Medicare?—Patti

Dear Patti,

If you have diabetes and your doctor says that you need diabetes self-management training and education, Medicare will cover up to 10 hours of self-management training for your first year, and two hours every following year under Medicare Part B.

Medicare Part B will also cover certain diabetic supplies, such as home glucose monitors and control solutions, lancets and test strips. You can get these benefits even if you don\'t use insulin.

If you use an external insulin pump (one worn outside the body), the insulin and the pump may be covered as durable medical equipment under Medicare Part B. Contact 800-MEDICARE (800-633-4227) for more information. .If you inject your insulin with a needle (syringe), the Medicare drug benefit (Part D) covers the cost of insulin and the supplies necessary to inject the insulin, including syringes, needles, alcohol swabs and gauze. Your Medicare drug plan will cover other medications to treat your diabetes at home as long as they are on your plan\'s list of covered drugs (\"formulary\").

Medicare will pay 80 percent of the Medicare-approved amount of all covered diabetes supplies and services, after you have paid the yearly Part B deductible. (If you are in a Medicare private health plan—HMO or PPO—you may have a copay for this service. Call your plan to find out what you will have to pay.)  —Marci

Dear Marci,
I want a second opinion from a different doctor. Will Medicare pay for it? —Doug

Dear Doug,

Medicare will pay for you to see a doctor and get a second opinion if a doctor has recommended that you have surgery or a “major diagnostic or therapeutic procedure.”

Medicare will also pay for a third opinion if the first and second opinions are different. The second and third opinions will be covered even if the surgery or other procedure is determined not to be covered.

If you want a third opinion but the first and second opinions were the same, you may be able to see a third doctor for a “confirmatory consultation.” Your insurance company may consider a “consultation” different from a third-opinion visit because it is done at the request of the patient. Medicare may cover the consultation as long as the third doctor submits a claim using the right code and writes in your medical record that the services provided were reasonable and medically necessary. If you are in a Medicare private health plan, your plan may only cover second and third opinions if you see network doctors or have a referral from your primary care doctor. Call your plan to find out their rules for seeking second opinions. —Marci

Dear Marci,
My income is slightly higher than the limit for Medicaid. Could I still qualify? —Charlie

Dear Charlie,

If you need Medicaid coverage, and your income is above the Medicaid income guidelines in your state, there are several ways you may still qualify for Medicaid coverage.

If you are above the limit but need the help, you should still apply. Depending on the Medicaid program and the rules in your state, certain income and assets may not be counted.

If you have high medical expenses, you may qualify for a Medicaid spend-down or “medically needy” program. The spend-down program is also referred to as Medicaid\'s “Excess Income Program.” Not all states have Medicaid Spend-Down programs.

In some states, trusts are a way for you to qualify for Medicaid if you are over the income or asset eligibility guidelines. These trusts, such as Miller Trusts and Supplemental Needs Trusts or Special Needs Trusts, allow people who have higher income or assets than the Medicaid eligibility guidelines to place a portion of their income or assets into the trust. Rules about how these trusts work vary greatly by state. If you are interested in participating in a trust, you should contact an elder law attorney.

Some states offer the Medicaid Buy-In program, which allows people who are under age 65 and have a disability to work (as little as one hour a month) and still get Medicaid benefits.—Marci

Marci’s Medicare Answers is a service of the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare. To speak with a counselor, call (800) 333-4114. To subscribe to “Dear Marci,” the Medicare Rights Center’s free educational e-newsletter, simply e-mail dearmarci@medicarerights.org. To learn more about the services that Medicare will cover and how to change plans, log on to Medicare Interactive Counselor at the Medicare Rights Center’s website at www.medicareinteractive.org.


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