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.
|
Mental Health and substance abuse care |
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 |
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 |
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 |