A new Medicare advantage plan could help diabetic beneficiaries in 30 Tennessee counties, including Hamilton, who struggle to control their Type 1 or Type 2 diabetes due to financial, transportation or other barriers.
While anyone with diabetes who's enrolled in Medicare can join, the plan is designed to give options to those who can't afford their care, said Dr. J.B. Sobel, BlueCross BlueShield of Tennessee's vice president and chief medical officer for senior programs. Benefits target some of the most common barriers to properly managing diabetes and include certain prescription and over-the-counter drug coverage, transportation, reduced coinsurance for continuous glucose monitors and insulin pumps, and lower copays for endocrinologists — the doctors who specialize in treating diabetes.
"A lot of this is looking at the downstream implications of poorly controlled diabetes," Sobel said. "Ongoing treatment and the secondary conditions you can develop from diabetes make it more costly and important to control."
For example, Medicare covers some routine podiatry services at a low rate, but the plan — called BlueEssential — increases those to six visits per year. That's because diabetes increases one's risk for foot damage, which when left untreated can turn into serious infections and require toe, foot or leg amputation.
Other complications of uncontrolled diabetes include cardiovascular disease, nerve damage, kidney damage and eye damage.
Casey Stephenson, a registered nurse and clinical manager from Endocrinology Consultants of East Tennessee, said diabetes is a "very quick downward spiral" when patients don't have the resources to control their blood sugar.
"That one little problem of not managing your blood sugar can quickly escalate into all of these other problems," Stephenson said.
To join BlueEssential, you must be entitled to Medicare Part A, be enrolled in Medicare Part B, and you
must live in the service area and have diabetes.
The service area includes these Tennessee counties:
West Tennessee: Chester, Fayette, Madison and Shelby
Middle Tennessee: Cheatham, Davidson, Robertson, Rutherford, Sumner, Williamson and Wilson
Southeast Tennessee: Anderson, Blount, Bradley, Grundy, Hamblen, Hamilton, Jefferson, Knox, Loudon,
Marion, Roane, Sequatchie, Sevier and Union
Northeast Tennessee: Carter, Hawkins, Sullivan, Unicoi and Washington
The plan is the first Medicare Chronic Condition Special Needs Plan ever launched in Tennessee, and is offered by BlueCross BlueShield of Tennessee. While it's too soon to know how many people may benefit from the plan, Stephenson said it's another tool that providers can use to better coordinate the often complicated care of diabetic Medicare patients.
Jill White, director of health IT and quality at Galen Medical Group, said low income Medicare patients often have to choose between getting their prescriptions filled or buying their groceries for the week.
"We work with social workers to try to get them resources, but having a special plan for these patients may help bridge the gap," she said.
The plan is a health maintenance organization option, meaning members choose from a select network of doctors, specialists and facilities — including pharmacies — for their health care needs. If providers are not included in the plan, members will likely need to select a new one unless it's an emergency.
Enrollment is open now with benefits starting Jan. 1, 2020. Because it's a special needs plan, beneficiaries can enroll any time throughout the year as long as they have diabetes. The only exception is for people currently on dialysis, who are not eligible for the plan.
Review the full list of benefits at bcbst-medicare.com or call 1-888-665-5678 (TTY: 711).
There is no premium for the plan, but members must continue to pay their Medicare Part B premium. This premium is normally taken out of Social Security checks each month.
Contact Elizabeth Fite at firstname.lastname@example.org or 423-757-6673.