Denver, CO. The Balanced Budget Act of 1997 provides coverage for diabetic services. This should reduce many of the out-of-pocket expenses for diabetics.

Effective January 1, 1998, Medicare covers blood glucose monitors and testing strips for Type I or II diabetics, without regard to the person's use of insulin.

To be eligible for benefits, the individual must first meet the annual $100 Part B deductible.

To file a claim, the individual needs a prescription from the physician on file with the pharmacy.

The pharmacy may file the claim with Medicare for the individual. If the pharmacy accepts assignment, Medicare will send the payment to the pharmacy.

If the pharmacy does not accept assignment, the individual will need to pay the pharmacy. The individual then needs to submit a copy of the receipt along with a Medicare claim form to Palmetto Government Benefits Administrator, PO Box 100141, Columbia SC 29202-3141. Medicare will send the individual a check for 80% of the approved amount. You can obtain the form at the following website.

If the individual has a Medicare supplement, the balance of the bill may be covered. The Medicare supplement is required to cover the 20% co-payment. Any excess charges may be covered by the Medicare supplement depending upon the individual's benefits.

Starting July 1, 1998, diabetic outpatient self-management training services are a covered benefit, as well. These services are covered if the physician certifies that the services are under a comprehensive plan of care. The goal of the training must be to ensure therapy compliance or to provide the individual with necessary skills and knowledge (including skills related to self-administration of injectable drugs) to participate in the management of their condition.

A physician or other individuals that provide other Medicare services can provide self-management training services.

The physician or other provider will bill Medicare for the self-management training services. If the provider accepts assignment, the individual will be responsible for a 20% co-payment. If the provider does not accept assignment, the individual will be responsible for the co-payment, as well as the excess charges.

If the individual is covered through an HMO, the glucose monitors, test strips and self-management training services are a covered benefit, but a co-payment may be required.