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Glucose Test Strips as Durable Medical Equipment Under Obamacare?

As I was perusing things health related, I came across the US Department of Labor’s webpage on The Patient Protection and Affordable Care Act (Obamacare).  As I was looking things over, the Uniform Glossary of Coverage and Medical Terms caught my eye.  Glossaries can be interesting things so I looked a little closer and the the definition of Durable Medical Equipment (DME) coverage caught my eye.  It reads (italics mine)

Durable Medical Equipment (DME)
Equipment and supplies ordered by a health care provider for everyday or extended use. Coverage for DME may include: oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.

Now documents like these tend to become statute (i.e. Law of the Land), so seeing test strips in there really concerns me.  Plans that I am aware of all have test strips as prescription items.  And honestly, I always found that odd as they seem to fall more into the category of medical supplies.  Medical supplies, by the way, are subject to the maximum out of pocket expenses limit of my plan, where there is no maximum for prescription items.  So there is a way that insurance has leveraged test strips to cost me more.

Personally, my DME coverage is limited to 3,000USD per year, where my prescription coverage is not.  That is an absolute limit, my maximum out of pocket does not apply to DME items.  Looking at things, it appears I would bear the full cost of test strips around the end of summer.  Unless of course, I need a new pump or CGMS which would cause that date to arrive much earlier in the year.

Combine this with the fact that flexible spending accounts are being limited to 2,500USD in 2013, I am not only looking at an huge additional cost burden but also an additional tax burden.

There are several things in Obamacare that I think are needed, such as no pre-existing condition exclusions, but there are even more, such as this one, that concern me greatly.

What the hell else is in here that people haven’t noticed yet?

©2011 Scott Strange, Strangely Diabetic and

  • I know that there are people in the DOC who pay nothing for their strips under their DME coverage. I pay nothing for my strips under my prescription coverage. 

    I’m not sure I want either to become the law of the land!

  • Kelly Booth

    I have a Medicare supplemental plan because of being on disability.  I have been on that plan since 2007 and have always purchased my strips thru the DME portion. 

  • kim

    over here, in Canada, i am paying $89.00/bx of 100 for test strips.  that is my total out of pocket expense.  i get nothing back.  my husbands coverage(through his employer) covers only $1000.00/yr per person, and is not interchangable.  he does not have any prescriptions.  i had used my portion ($1000.00) after only about 4mths.  test strips are not covered under diabetic medical equipment.  they fall under prescriptions, as do needle tips, syringes, lancets, glucagon.  when i worked full time, the benefits i had with my company had no limit on prescriptions, and therefore i didn’t have to worry about how many strips i used (because if we test a minimum of 4X/day, they last less than a month as we all know!).

  • Yikes.

    Me no likey!!!!We pay a hefty copay every 3 months for prescription coverage of strips, but there’s no max.  Our current policy doesn’t have a max for DME, but that hasn’t always been the case, and won’t necessarily remain the case as my husband would like to make a career change.  I would HATE to see this take effect for the exact reason you describe.

  • OUCH!  I don’t like moving in that direction.  I have no cap on my Rx coverage but I have a cap on DME.  Typically, the cap gets lower and lower over the years.  It’s one thing to choose between spending DME allowance on pump supplies or on CGM supplies, but if you put test strips in there…that’s a whole other balancing act.  Thanks for the link…I’ve been wanting to read through for a while and didn’t know where to look.

  • This is one area where this law may simply be too specific for no apparent reason, and for people like yourself, this will no doubt be an issue.  Still, you might read on to determine if there is a change to DME maximums as well (there might be). On the other hand, the law aims to bring coverage to more people since an estimated 40% of all people living with diabetes, including many of whom who are actually working, lack any sort of healthcare coverage whatsoever.  This may impact some adversely while doing good for many more.