Medicare Advantage diabetes benefits

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Benefits that support diabetes management

If you are diabetic, you could use a little extra help. Our Medicare Advantage plans offer specific benefits geared toward those needs.



Important message about what you pay for insulin

You won’t pay more than $35 at a non-preferred pharmacy or $30 at a preferred pharmacy for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on. 

Getting Help from Medicare - If you chose this plan because you were looking for insulin coverage at $35 a month or less, it is important to know that you may have other options available to you for 2023 at even lower costs because of changes to the Medicare Part D program. 

Contact Medicare, at 1-800- MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week for help comparing your options. TTY users should call 1-877-486-2048. 

  • Additional resources to help – Contact our Customer Care Center at 314-301-3326 (TTY:711)  [8 am-8 pm Mondays-Fridays (year-round) and weekends (Oct. 1-March 31).


Managing your diabetes

If you have diabetes, make sure you are taking steps to stay healthy. These are approved and covered by your health plan:

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Struggling to manage your diabetes? We can help you! Complete our Care Management form to be connected with a nurse who will provide you with the support you need. Just select complex case management and care coordination. 


Insulin savings

Does insulin play a role in managing your diabetes? We can help. Our plans offer reduced copays on insulin even through the donut hole. We offer:

  • $30 insulin fills at preferred pharmacy locations.
  • $35 insulin fills at standard retail pharmacies.


Find preferred pharmacy and standard retail pharmacy locations.

Our insulin savings program applies to all insulins on the prescription drug list/formulary*, including:

  • Fiasp 100 unit/ml
  • Humulin R 500 unit/ml
  • Levemir 100 unit/ml
  • Novolog 100 unit/ml
  • Lantus 100 unit/ml
  • Novolin N 100 unit/ml
  • Novolin R 100 unit/ml
  • Toujeo 300 unit/ml
  • Toujeo 100 unit/ml
  • Tresiba 100 unit/ml
  • Tresiba 200 unit/ml
  • Xultrophy 100unit-3.6ml, 
  • Soliqua 100unit-0.033mg/ml ; 
  • Novolin (70/30) mix 100unit/ml; 
  • Insulin Aspart Human 100unit/ml; 
  • Insulin aspart Protamine, (70/30) MIX 100unit/ml;

* Includes pen injector, injectable solution, injectable suspension and cartridge.


Diabetic supplies

$0 diabetic supplies 

Supplies to monitor your blood glucose are covered at $0. Covered supplies include blood glucose monitors, blood glucose test strips, lancet devices and lancets, and glucose-control solutions for checking the accuracy of test strips and monitors. Diabetic testing supplies must be Accu-Chek brand in order to be covered.

Continuous glucose monitors

We cover all continuous glucose monitors (CGM) at $0. You can receive Freestyle Libre or Dexcom CGMs through retail pharmacies.  Other CGMs must be obtained through a medical supply company.

Ask your doctor if you meet Medicare guidelines for the $0 CGM benefit. To receive a CGM, your doctor needs to follow Medicare guidelines, and submit a request for approval for it to be administered.

Insulin pumps

Insulin pumps covered by our plan are Minimed, T Slim and Omnipod. Minimed and TSlim are covered under the durable medical equipment (DME) benefit. You will pay 20% coinsurance in-network for insulin pumps. Omnipod supplies can be purchased at a retail pharmacy at your 20% Part B copay.

To receive an insulin pump, your doctor needs to follow Medicare guidelines, and submit a request for approval for TSlim or Minimed for your insulin pump to be administered. 

Insulin supplies

Insulin supplies are covered under the Part D benefit. Covered insulin supplies include syringes, needles, alcohol swabs and gauze. Insulin supplies will be $0 at your local or mail-order pharmacies. 

$0 Part C benefits

PCP visits

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Outpatient mental health

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Labs

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Diabetic supplies

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Kidney disease education

Therapeutic shoes and inserts

For people with diabetes who have severe diabetic foot disease, we cover one pair of therapeutic custom-molded shoes or depth shoes per calendar year. This coverage includes fitting. You will pay 20% coinsurance in-network for therapeutic shoes and inserts. Therapeutic shoes and inserts are only available through NPS Foot Health.


Additional benefits

  

View our Medicare disclaimer.
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Updated: 10/1/22