As a reminder, Qualified Medicare Beneficiaries (QMBs), including some UnitedHealthcare Medicare Advantage members, are not responsible for any remaining balance after payment from Medicare for covered services. The Centers for Medicare & Medicaid Services (CMS) guidelines state that Medicare-contracted care providers may not collect cost-share from these patients.

To determine if you can bill Medicaid as the secondary payer, please review the information found in the Benefit Stage Qualifier field of the approved Medicare Advantage claim. Code 50 in that field indicates that the claim was paid under Part B benefits, even if the drugs were processed using a Part D Processor ID or control number. This is because Medicare Advantage, also known as Part C, combines Part A, Part B and Part D benefits. If this is the case and the member is an active QMB, you can bill the dollar amount found in the Qualifier Amount field to Medicaid.

The Medicare Advantage plans listed below will be implementing coverage changes for their enrollees’ diabetic supply needs. Beginning this plan year, these plans will only cover LifeScan, Inc., OneTouch® or Roche Diagnostics, ACCU-CHEK® diabetic glucometers and blood test strips when purchased from an in-network pharmacy.

*Please see attached PDF for more information.

The Medicare Advantage plans listed below will be implementing coverage changes for their enrollees’ diabetic supply needs. For this plan year, the plans will continue to only cover LifeScan, Inc., OneTouch® or Roche Diagnostics, ACCU-CHEK® diabetic glucometers and test strips. One glucometer will be covered every 180 days.

The plans will only cover Roche, Prodigy, Owen Mumford, Perrigo, Lifescan and Good Neighbor lancets.