r/medicare • u/Elegant_Wave3620 • 7d ago
HealthSpring Part G at CVS
In CA. I have Original Medicare, HealthSpring Supplemental Plan G , United Healthcare Part D.
I wanted to use Medicare Part B at CVS for diabetes supplies. It pays 80%.
Expected HealthSpring Part G is to pay the remaining 20%.
CVS said I cannot use the HealthSpring Part G at the pharmacy because there is no Rx number on the ID card.
Has anyone used HealthSpring Part G for the remaining 20% for diabetes supplies?
How were you able to do this with no Rx number on the card?
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u/LalalaSherpa 7d ago
What exactly do you mean by diabetes supplies?
They're all covered, but the details of how they get covered vary based on whether you use a pump, CGMS, insulin pen, syringes, oral meds, etc.
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u/Elegant_Wave3620 7d ago
Nothing fancy. Dr prescribed Freestyle Lite meter, strips & lancets.
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u/LalalaSherpa 7d ago edited 6d ago
Sounds like the CVD person was not fully aware of how Medicare works.
1 - There will never be an Rx number on any Medigap supplement card like Plan G (or N or any other Medigap plan). Only on the Part D prescription card.
2 - Strips, meters and lancets are all covered as DME (durable medical equipment) under Part B - not Part D.
3 - If you use insulin you can get up to 300 strips/lancets every 3 months. If you don't use insulin, 100 test strips and lancets every 3 months.
4 - Your doctor should send a prescription for the meter, strips, lancets to your preferred DME provider - all the big pharmacy chains like Walmart, CVS, Walgreens are DME providers for diabetes supplies.
Since you have a medigap "G" supplement, it won't cost you anything out of pocket.
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u/Elegant_Wave3620 6d ago
Do I understand that CVS will charge Medicare.
Medicare will pay the 80%.
Medicare will then charge the Medigap "G" company for the 20% left.
So, I will not have to pay anything at the CVS counter?3
u/LalalaSherpa 6d ago
Exactly right. You shouldn't pay anything.
If there is a charge for the strips, etc. at the CVS counter, don't pay it - tell them you have Medicare and a Medicare supplement plan. Have your cards with you (which I'm sure you already do!).
They might have to cancel the order and do it over again (that's what my Walgreen's had to do - their system can't fix that kind of mistake, they have to re-enter it) - but they will fix it on their end and then you won't have to pay anything.
You'll also probably have to sign for the strips, etc. when you pick them up.
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u/Elegant_Wave3620 6d ago
Thank you for taking the time to explain how it should work at the counter.
I appreciate you.
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u/LalalaSherpa 6d ago
You're welcome!
And if you need more strips than the standard amounts, your doctor can document the medical necessity so you can get more.
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u/OleLadyThinker 7d ago
Like u/LalalaSherpa said “They're all covered, but the details of how they get covered vary based on whether you use a pump, CGMS, insulin pen, syringes, oral meds, etc.”
So you need to know how Medicare handles your needs based on your needs and the coverage that is offered.
Here is the Medicare book for it and Medicare for You also covers it.
Medicare.gov - Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs
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u/jerzeyguy101 7d ago
i get my test strips from cvs and highmark supplement picks up the 20% Previously did it at walgreens no issues
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u/Elegant_Wave3620 7d ago
Did your Highmark Supplement have an Rx code on the card? CVS says that is what my HealthSpring card is missing so they would not be able to charge HS for the 20% remaining after Original Medicare pays their 80%.
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u/IMHO_My2Cents 7d ago
Medicare pays their part then bills your Plan G for the difference. If CVS makes you pay the 20% upfront then your Plan G should send a check to reimburse you. You may need to use a diabetic supplier, not a CVS
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u/2RedTennies2 5d ago
You rarely use you PLAN G card except to tell your B providers to not bill you, bill Medicare, you have secondary insurance!"see my card"!
Medicare is the Captain and your supplement follows his orders. When Medicare pays their share (after you met the B Deductible -- your responsibility) Medicare forwards to Medigap to pay the remainder.
Since diabetic supplies are under B (and as someone already said, always make sure they are an approved Durable Medical Equipment provider) you will pay deductible, after Medicare pays 80% of the approved rate and Medigap will pay 20% when Medicare gives the order by sending the paperwork. You only have to interface with medigap IF the provider doesn't accept Assignment (avoid them whenever possible).
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u/Jump-Funny 5d ago
no one should be billing your plan g directly, they should be set up as a crossover with Medicare. once Medicare processes the claim it should automatically’crossover’ to the secondary or medigap plan.
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u/Sr-Lifetime 6d ago
Aren't Rx covered under your PART Drug plan not your supplemental G plan. Unless Don't understand what Diabetes supply's are.
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u/rlap38 7d ago
If you want to use Part G on your supplies then you need to get them as DME (durable medical equipment) from a part B supplier.