Railroad Medicare Coverage of Supplies if You Have Diabetes

Railroad Medicare covers certain supplies if you have Medicare Part B and have diabetes. These supplies include:

•    Blood glucose self-testing equipment and supplies
•    Therapeutic shoes and inserts
•    Insulin pumps and the insulin used in the pumps

Blood Glucose Self-testing Equipment and Supplies
Blood glucose self-testing equipment and supplies are covered for all people with Medicare Part B who have diabetes. This includes those who use insulin and those who do not use insulin. These supplies include:
•    Blood glucose monitors
•    Blood glucose test strips
•    Lancet devices and lancets
•    Glucose control solutions for checking the accuracy of testing equipment and test strips

Railroad Medicare covers the same type of blood glucose testing supplies for people with diabetes whether or not they use insulin. However, the amount of supplies that are covered varies.
If you:

1.    Use insulin, you may be able to get up to 100 test strips and lancets every month, and 1 lancet device every 6 months
2.    Do not use insulin, you may be able to get 100 test strips and lancets every 3 months, and 1 lancet device every 6 months
If your doctor documents why it is medically necessary, Railroad Medicare will cover additional test strips and lancets for you.
Medicare and Railroad Medicare will only cover blood glucose self-testing equipment and supplies if you get a prescription from your doctor which includes:
•    That you have diabetes
•    What kind of blood glucose monitor you need and why
•    Whether or not you use insulin
•    How often you need to test your blood glucose

Medicare will not pay for any supplies not asked for, or for any supplies that were sent to a beneficiary automatically from suppliers. This includes blood glucose monitors, test strips, and lancets. Also, if a beneficiary goes to a pharmacy or supplier that is not enrolled in Medicare, Medicare will not pay. The beneficiary will have to pay the entire bill for any supplies from non-enrolled pharmacies or non-enrolled suppliers.

All Medicare-enrolled pharmacies and suppliers must submit claims for blood glucose monitor test strips. You cannot submit a claim for blood glucose monitor test strips yourself. You should make sure that the pharmacy or supplier accepts assignment for Medicare-covered supplies. If the pharmacy or supplier accepts assignment, Medicare will pay the pharmacy or supplier directly. You should only pay your coinsurance amount when you get your supply from your pharmacy or supplier for assigned claims. If your pharmacy or supplier does not accept assignment, charges may be higher, and you may pay more. You may also have to pay the entire charge at the time of service and wait for Medicare to send you its share of the cost.

Before you get a supply, be sure to ask the supplier or pharmacy the following questions:
•    Are you enrolled in Medicare?
•    Do you accept assignment?
If the answer to either of these two questions is 'no,' you may wish to consider calling another supplier or pharmacy in your area that answers 'yes' to be sure your purchase is covered by Medicare.

Therapeutic Shoes and Inserts
If you have Medicare Part B, have diabetes, and meet certain conditions (see below), Railroad Medicare will cover therapeutic shoes if you need them. The types of shoes that are covered each year include one of the following:
•    One pair of depth-inlay shoes and three pairs of inserts or
•    One pair of custom-molded shoes (including inserts) if you cannot wear depth-inlay shoes because of a foot deformity and two additional pairs of inserts

Note: In certain cases, Medicare may also cover shoe modifications instead of inserts.
In order for Medicare to pay for your therapeutic shoes, the doctor treating your diabetes must certify that you meet all of the following three conditions:

•    You have diabetes
•    You have at least 1 of the following conditions in one or both feet
o    Partial or complete foot amputation
o    Past foot ulcers
o    Calluses that could lead to foot ulcers
o    Nerve damage because of diabetes with signs of problems with calluses
o    Poor circulation, or
o    Deformed foot
•    You are being treated under a comprehensive diabetes care plan and need therapeutic shoes and/or inserts because of diabetes

Medicare also requires the following:

•    A podiatrist or other qualified doctor must prescribe the shoes, and
•    A doctor or other qualified individual like a pedorthist, orthotist, or prosthetist must fit and provide the shoes to you

Medicare helps pay for one pair of therapeutic shoes and inserts per calendar year, and the fitting of the shoes or inserts is covered in the Medicare payment for the shoes.

Insulin Pumps and the Insulin Used in the Pumps
Insulin pumps worn outside the body (external), including the insulin used with the pump, may be covered for some people with Railroad Medicare coverage who have diabetes and who meet certain conditions. If you need to use an insulin pump, your doctor will need to prescribe it.

Railroad Medicare covers the cost of insulin pumps and the insulin used in the pumps. However, if you inject your insulin with a needle (syringe), Medicare Part B does not cover the cost of the insulin, but your Medicare prescription drug benefit (Part D) covers the insulin and the supplies necessary to inject it. This includes syringes, needles, alcohol swabs and gauze. Your Medicare Part D plan will cover the insulin and any other medications to treat diabetes at home as long as you are on the Medicare Part D plan’s formulary.

Coverage for diabetes-related durable medical equipment (DME) is provided as a Medicare Part B benefit. The Medicare Part B deductible and coinsurance or copayment applies after the yearly Medicare part B deductible has been met.

RAILROAD RETIREMENT PREFIXES and its explanation

               PREFIX                                   DESCRIPTION

A                                 Retired railroad worker (Annuitant)

H                                 Retired worker on a pension

JA                                Survivor “Joint Annuitant”: an employee who is receiving a reduced annuity in order to guarantee payment to his widow.

MA                              Spouse of Annuitant

MH                              Spouse of Pensioner

PA                               Parent of deceased Annuitant

PD                               Parent of deceased Employee

PH                               Parent of deceased Pensioner

WA                             Widow or widower (of an Annuitant) who is 60 or over

WCA                           Widow with a child in her care or a child alone.

WD                             Widow or widower (of an employee) who is 60 or over

WCD                           Widow (of an employee) with a child in her care or a child alone.

WH                             Widow or widower of a pensioner

WCH                           Widow (of a pensioner) with a child in her care or a child alone.

              

Enrolling and understanding the basics of RR Medicare

Enrolling in Railroad Medicare

Individuals who have worked for a minimum of 10 years in their railroad industry may pre-enroll or enroll in this plan. Enrollment forms, known as the EDI Enrollment Packet, are available from Palmetto GBA. Otherwise, eligibility standards are the same for those receiving Railroad Medicare as those receiving Medicare in the general population through the Social Security Administration. Individuals 65 years of age or older are eligible for Medicare Part A (hospital insurance), at no cost if they are able to receive Social Security benefits or Railroad Retirement benefits.

Individuals are also eligible for Railroad Medicare services if they are under 65 years of age and are suffering from permanent disabilities, or if a senior has been diagnosed with Lou Gehrig's disease (amyotrophic lateral sclerosis), or have been diagnosed with permanent kidney failure or if the senior receives occupational disability under certain circumstances.

Railroad Medicare - Understanding the Basics


Railroad Medicare is the name given to individuals receiving benefits from the Railroad Retirement Board (RRB), whose benefits are designed for workers and family's under the auspices of the Railroad Retirement and Railroad Unemployment Insurance Acts.

Benefits are offered to individuals who have worked 10 or more years of railroad service. Retirement benefits for such employees are determined by the Retirement Board, while services, claims, benefits, eligibility and enrollment is provided through Railroad Medicare:

Palmetto GBA Railroad Medicare Part B P.O. Box 10066, Augusta, Georgia 30999.


Palmetto GBA has been offering these services in conjunction with the Centers for Medicare and Medicaid Services (CMS) for four decades and is the Part B carrier for RR Medicare throughout the nation, contracted by the Railroad Retirement Board for retirement/survivors, and unemployment/sickness benefit programs for workers and their families.

RR medicare and its Benfits

What Does Railroad Medicare Cover?


It basically covers the same as traditional government services, except that beneficiaries are RR retirees. The plan contains Part A benefits, covering hospitalization costs similar to those found in traditional Medicare Part A. Part B is paid for by monthly premiums from Federal government funding revenues or by individuals, determined by employment history.

As with traditional services, Part B coverage offers help in paying for services provided by physicians and physician-based medical services not covered in Part A, which includes doctors services, laboratory services, outpatient hospital services, preventive services, and Home Health Care Services, and many other benefits.
Part A medical benefits include hospital insurance, which helps to pay for skilled nursing facilities following a hospital stay, and inpatient care in a hospital, as well as some hospice care and Home Health Care Services.
RR Medicare offers coverage to railroad workers in a similar format as those covered under Social Security benefits, and railroad retirement payroll taxes also include hospital insurance tax for Medicare, just like Social Security taxes do.

For those retiring from railroad service, the Railroad Retirement Board enrolls employees into the program, and premiums are generally deducted from monthly benefit payments.


Benefits of Railroad Medicare

Individuals submit claims to the Centers for Medicare and Medicaid Services (CMS) or a designated CMS contractor, through its agents, or employers.

Individuals working in the railroad industry should contact Medicare regarding Railroad Retirement Benefits at Railroad Benefits to read RB-20 January 2010 - Medicare for Railroad Workers and their Families to access the information booklet in its entirety. Additional questions may be broached to Palmetto GBA for clarification regarding eligibility, enrollment periods, claims processing, or answers to general questions and facts regarding benefits and services.