Doctor visits
with your primary care doctor or other primary care provider |
You may have to pay a copay. |
Medical benefit, covered under Medicare Part B which is included in Medicare Advantage plans.
You may have to pay a copay. |
| Specialist visits and education |
Talk to your primary care provider about seeing an in-network specialist. Your doctor and specialist can work together to coordinate your care.
You may have to pay a copay for visits to: - Endocrinologist/diabetologist
- Ophthalmologist/optometrist (one dilated-eye exam per year at a participating doctor)
- Medical nutrition therapy (up to six visits per contract year)
- Diabetes self-management education
- Podiatrist (for diabetes-related foot care)
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Covered under Medicare Part B, which is included in Medicare Advantage plans.
You may see a specialist without a referral, but it's always good to have your primary doctor coordinate your care.
You'll pay less if you see a specialist who has a Priority Health Medicare contract.
You may have to pay a copay for visits to: - Endocrinologist/diabetologists
- Ophthalmologist/optometrists (one dilated-eye exam per year at a participating doctor)
- Dietitian consult or medical nutrition therapy
- Diabetes self-management education
- Podiatrist (for diabetes-related foot care)
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Mental Health and substance abuse care
Get the help you need if you have feelings of depression for more than two weeks or if you suffer from substance abuse.
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- The first step is calling our Behavioral Health department at 800 673-8043. A case manager will determine what treatment options are appropriate and authorize services.
- You don't need a referral to get help.
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- The first step is calling our Behavioral Health department at 800 673-8043. A case manager will determine what treatment options are appropriate and authorize services.
- For outpatient mental health care, you may see any mental health provider without a referral.
- For some outpatient substance abuse services, you will need a referral.
- You'll pay less when you see a mental health provider who has a contract with Priority Health Medicare.
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| Insulin and oral medications |
- Covered by your pharmacy benefit. Check your member ID card to verify that you have prescription coverage.
- Use our home delivery pharmacy to save money. Your doctor must write you a prescription for a 90-day supply. Then you'll pay one or two copays instead of three for a 90-day supply, and shipping is free.
Learn more about our home delivery pharmacy.
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Covered by your Medicare Part D pharmacy benefit, which is included in all Priority Health Medicare Advantage plans and by PriorityMedicare RxSM.
Learn more about Medicare Parts A, B and D.
Under Part D, you will pay only a copay for: - Insulin and oral medications
- Needles, pen needles and syringes
- Use our home delivery pharmacy to save money. Your doctor must write you a prescription for a 90-day supply. Then you'll pay 2.5 copays instead of 3 for a 90-day supply, and shipping is free.
Learn more about our home delivery pharmacy.
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| Glucometers |
- Free glucose monitors may be available. See chart below or contact Customer Service.
- Only covered by your medical benefit. If you use this benefit, you may have to pay a copay.
- You'll need a prescription for your glucometer from a Priority Health doctor.
- You don't need prior approval to get a standard glucose monitor.
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Covered by your medical benefit for durable medical equipment (DME) under Medicare Part B, which is included in Medicare Advantage plans. PriorityMedicare Rx (Part D-only) members are not covered. - You don't need prior approval from Priority Health to get standard glucose monitors. But, you can only get them from a DME provider (not from a pharmacy) if you want your plan to pay for them. Otherwise, call the numbers below to get them for free.
- You'll need a prescription for your glucometer from a Priority Health doctor.
- You'll pay a $0 copay when you have a prescription for supplies from a Priority Health doctor.
- See your Evidence of Coverage booklet for more information on your DME benefits.
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| Test strips, lancets and lancet devices |
Covered by your medical or pharmacy benefit. Check your member ID card to verify that you have prescription coverage. You may have to pay a copay. Prescription coverage will pay for: - Test strips, lancets and syringes
- You can get some kinds of test strips and lancets for a generic copay (see chart below). Call Customer Service for more information.
- There's a 3-month supply limit on blood glucose test strips and lancets. If you need more, contact your doctor.
- You can get a lancet device once every 6 months under your medical benefit.
Money-saving tip: Check your DME copay vs. your pharmacy copay. In some cases, you'll pay less if you get your supplies from a DME provider (list below). If you don't have pharmacy coverage, use your DME benefit. |
Covered by your medical benefit for durable medical equipment (DME) under Medicare Part B, which is included in Medicare Advantage plans. PriorityMedicare Rx (Part D-only) members are not covered. - You'll need a prescription for your test strips from a Priority Health doctor. Then you'll pay a $0 copay.
- You can only get a 3-month supply of test strips at one time. If you need more, you must have prior approval from Priority Health.
- See your Evidence of Coverage booklet for more information on your DME benefits.
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| Shoe inserts/diabetic shoes and other equipment |
You may have to pay a copay.
You'll need a prescription for your DME supplies from a Priority Health doctor. - Insulin pumps, continuous glucose monitoring systems, shoe inserts and diabetic shoes must meet Priority Health policy criteria and may require prior authorization.
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Covered by your medical benefit for durable medical equipment (DME) under Medicare Part B, which is included in Medicare Advantage plans. PriorityMedicare Rx (Part D-only) members are not covered. - You'll need a prescription for your DME supplies from a Priority Health doctor. Then you'll pay a $0 copay.
- Shoe inserts and diabetic shoes must meet Medicare criteria.
- See your Evidence of Coverage booklet for more information on your DME benefits.
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