Does Navicare Cover Contour Next Gen Glucose Strips in Mass.

Does navicare cover contour next gen glucose strips in mass., Find out if NaviCare in Massachusetts covers Contour Next Gen glucose test strips under Medicare/Medicaid.

Imagine waking up, testing your blood sugar, and worrying whether your strips are actually covered. That’s real anxiety. You want clarity, not labyrinthine plan jargon. So let’s cut through the noise and focus on what’s vital, does NaviCare support Contour Next Gen glucose strips for MassHealth/Medicare members in Massachusetts?

A Quick Snapshot: What Is NaviCare?

NaviCare is Fallon Health’s integrated Medicare–Medicaid program in Massachusetts, designed for eligible folks 65+ with MassHealth Standard, and often Medicare too. It tailors a care plan with a blend of in-home support and medical coverage, no cookie-cutter approach here.

Important to know: covered diabetic supplies depend heavily on preferred providers and brand-specific rules.

General Diabetic Supply Coverage Under NaviCare

NaviCare’s pharmacy rules say:

• Blood glucose meters and test strips for non-preferred brands require prior authorization.
• Preferred meters include OneTouch® (by LifeScan) and FreeStyle or Precision Xtra (Abbott).

So Contour Next Gen? It’s neither OneTouch nor Abbott-brand. That raises red flags on automatic coverage.

What Medicare Part B Says About Contour Next

On the federal side, Ascensia Diabetes Care (manufacturer of Contour Next) confirms:

• Contour Next test strips are always covered under Medicare Part B.
• Patients pay 20% after the Part B deductible, unless they have supplemental coverage.

But here’s the catch, NaviCare isn’t straight-up Medicare. It’s a blend, and its formulary and authorization rules may override the general federal rule.

Does NaviCare Cover Contour Next Gen in MA?

Let’s lay it out clearly:

1. Federal Medicare Part B: Yes, Contour Next is covered nationwide, including Contour Next Gen strips, but with standard 20% coinsurance post-deductible.

2. NaviCare (Fallon Health’s Medicare-Medicaid plan):

• Policies favor OneTouch and Abbott products.
• Contour is a non-preferred brand, prior authorization is required, and coverage isn’t guaranteed.

3. MassHealth Component: This may echo NaviCare’s restriction, enforcing preferred-branded supplies unless medically justified.

So, short answer: No, NaviCare does not freely cover Contour Next Gen strips, in Massachusetts, they fall under the “non-preferred” category and need prior authorization.

Why This Matters (and Why You’re Not Alone)

Dealing with diabetes management is already a tightrope walk. Throw in a plan that favors certain brands, and the logistical stress spikes.

You might wonder: “Why not just use OneTouch or Abbott?” Perhaps you’ve tried Contour and prefer its accuracy, ease, or app compatibility. That preference should count, but the system rarely bends unless you have leverage.

How to Navigate the Authorization Maze

Here’s how to fight for Contour Next Gen coverage:

1. Talk to Your Doctor Get a written statement: there’s a medical necessity for Contour over preferred alternatives, maybe due to accuracy, allergies, or dexterity challenges.

2. Submit a Prior Authorization Your provider must file with Fallon Health (NaviCare). Make it rock-solid with test results, documented history, and your signed statement.

3. Be Ready to Appeal If denied, don’t give up. You can escalate, file an appeal, involve advocates, or ask for peer review. Stay persistent.

4. Consider Medicare-only fallback If your MassHealth isn’t crucial, and you only qualify via Medicare, buying via Medicare Part B could be smoother (20% cost, no PA needed).

5. Use Manufacturer Programs Contour Next often has Co-Pay Savings or Choice programs, sometimes cheaper than out-of-pocket prices.

Walkthrough Example, Meet Jane

• Jane, 70, lives in MA, on NaviCare for Medicare–Medicaid.

• She likes Contour Next Gen because its smartLIGHT feature makes readings visible in dim light, critical for her visual impairment.

• She tries to refill at the pharmacy and gets a denial: “non-preferred brand.”

• Jane’s doctor writes “Contour Next Gen medically necessary; Do not substitute.”

• PA gets submitted.

• If approved: she gets her preferred strips.
• If denied: she appeals citing ADA accommodations and failure of other meters for her.

• Meanwhile, she checks Contour’s assistance program to save on out-of-pocket cost.

Every move Jane makes is strategic, but this is what it takes when policy doesn’t match user needs.

Key Takings

• NaviCare is an integrated Medicare–Medicaid plan in MA with a specific network and formulary.

• Contour Next Gen glucose strips are not preferred; thus, not automatically covered, they require prior authorization.

• Under Medicare Part B, Contour Next strips are covered (80/20 rule after deductible).

• To pursue coverage via NaviCare:

• Document medical necessity.
• File prior authorization.
• Be ready to appeal decisions.

• Manufacturer’s savings programs may reduce your cost, regardless of coverage status.

Additional Resources:

• Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs (PDF): A federal guide detailing Original Medicare coverage including meters, strips, insulin, quantities, and conditions, with information to compare NaviCare vs standard Medicare.
• MLN7674574 – Medicare Coverage of Diabetes Supplies – CMS (PDF): Clinical fact sheet explaining durable medical equipment coverage under Part B, outlining the 80/20 payment split, quantity limits, and durable equipment rules.