Insurance Information

Type 1 insurance guide offered by JDRF

Juvenile Diabetes Research Foundation has developed a tool tailored to persons with type 1 diabetes. The guide covers terms, costs, how to handle pre-authorizations, and denials. 

Medicare

If you are over 65 years old and have Medicare, here are some resources to help you manage your diabetes with Medicare. 

Medicare Coverage of Diabetes Supplies and Devices 

Medicare's National Mail Order Program for Supplies 

Navigating the Medicare Maze to Save Money (updated April 2018)

Priority Health 

Diabetes supplies are a confusing area. Priority Health plans cover them differently depending on which Priority Health plan you have. This page will help you figure out what diabetes supplies are covered for you.

Some diabetes supplies are covered by your health plan (your "medical benefit") and others by your prescription plan (your "pharmacy benefit"). For example:

  • Glucometers are considered to be "durable medical equipment" (DME) so they're covered by your medical benefit. Tip: Get glucometers free from the manufacturers using the contact information below. Call Customer Service or contact your case manager for more information. 
  • Test strips are covered by your medical or pharmacy benefit for most individual and group plans.

If your plan has a deductible, you'll pay full price for services (less the Priority Health discount) until you've met the deductible. These two tables highlight what is covered by your plan for diabetes health care. 

This is information was updated 09/19/2017.  If you are have any questions regarding your benefits, please contact your provider directly. 

Service

How It's Covered By PriorityHMOSM,  PriorityPPOSM, PriorityPOSSM, Medicaid and  MyPriority®

Doctor visits with your primary care doctor or other primary care provider

Covered by your medical benefit. You may have to  pay a copay.

Specialist visits and education

Covered by your medical benefit. Talk to your  primary care provider about seeing an in-network specialist. Your doctor and specialist can work together to coordinate your care. 

You may have to pay a copay for visits to: 

  • Endocrinologist/diabetologist 
  • Ophthalmologist/optometrist (one dilated-eye exam per year at a participating doctor) 
  • Medical nutrition therapy (up to six visits per contract year) 
  • Diabetes self-management education 
  • Podiatrist (for diabetes-related foot care) 

Mental Health and substance abuse  care 

Get the help you need if you have  feelings of depression for more than two weeks or if you suffer  from substance abuse. 

Covered by your medical benefit. The first step is calling our Behavioral Health department at 800-673-8043. A case manager will determine what treatment  options are appropriate and authorize services. 

You don't need a referral to get help. 

Insulin and oral medications

Covered by your pharmacy benefit. Check your  member ID card to verify that you have prescription  coverage. 

Use our home delivery pharmacy to save money. Your doctor must write you a prescription for a 90- day supply. Then you'll pay one or two copays instead of three for a 90-day supply, and shipping is free. 

Glucometers

Glucometers are "durable medical equipment." They  are covered by your medical benefit. You may have  to pay a copay. 

Free glucose monitors may be available. See chart  below or contact Customer Service

You don't need prior approval to get a standard  glucose monitor, but you'll need a prescription for  your glucometer from a doctor in your plan's  network. 

Blood glucose test strips
Ketone test strips
Lancets and lancet devices
Insulin syringes and pen needles

Supplies are covered by your medical OR  pharmacy benefit. 

Money-saving tip: Check your DME copay vs. your pharmacy copay. In some cases, you'll pay less if you get your supplies from a DME provider. If you don't  have pharmacy coverage, use your DME benefit. 

Blood glucose test strips

There's a 200-strip limit on blood glucose test strips  and lancets if you order from a pharmacy. If you need  more, contact your doctor.

You can get some kinds of blood glucose test  strips for a generic (tier 1) copay (see chart  below). Call Customer Service for more information. 

Lancet devices: Under your medical benefit, you  can get a new lancet device once every 6 months. 

Insulin delivery device (V-Go)

Covered by your pharmacy benefit. You may have to  pay a copay.

Insulin pumps, continuous glucose  monitoring systems

Covered by your medical benefit. You may have to  pay a copay.

Insulin pumps and continuous glucose monitoring  systems must meet Priority Health policy criteria and  may require prior authorization. 

Shoe inserts/diabetic shoes and  other equipment

Covered by your medical benefit. You may have to  pay a copay. 

You'll need a prescription for your DME supplies  from a doctor in your plan's network. 

Shoe inserts and diabetic shoes must meet Priority  Health policy criteria and may require prior  authorization. 

 

 Brand

 Glucometer  Name

 Covered By  These Plans

 How To Get A Free Glucometer

Abbott

Any Freestyle meter

Medicaid

PPO, HMO, EPO,  POS: Tier 3 copay applies

Call toll-free 866-224-8892.

Ascensia

Contour Next  (formerly  Bayer)

Medicaid

PPO, HMO, EPO,  POS: Tier 3 copay applies

Call toll-free 800-432-9131 (option 2) and mention ID code BDC-PH.

LifeScan

OneTouch Ultra products
One Touch Verio products including
One Touch Verio Flex

PPO, HMO, EPO,  POS: Tier 1 copay applies

Call toll-free 888-883-4252, and use order  code 515ESI002

Roche

Accu-Chek products

PPO, HMO, EPO,  POS: Tier 3 copay applies

Contact Solara Medical Supply at 888-474-9912