Sharp's diabetes coverage – Diabetic supplies, medication, and equipment coverage.

Sharp's diabetes coverage – Diabetic supplies, medication, and equipment coverage. 

Depending on which Sharp plan you signed up for (Classic, Select, Saver, Direct Advantage) you get different levels of coverage for diabetic supplies, screenings, specialist copayment, and prescription medication. No matter which plan you enroll in, you’ll have access to coverage for diabetic supplies (test strips, insulin pumps, glucose monitors, etc.), medication (insulin, glucagon, etc.), and doctor visits to both primary care and specialists.  

Check below for information about your specific plan.  

Note that the numbers below are current as of 4/1/2024.  

Quick Overview of our Plans 

The Classic Plan offers the most coverage out of all of our non-Medicare Sharp plans but is also the most expensive when it comes to monthly premiums.  

The Select Plan is our “in-between” option, it offers very good coverage for value and is more affordable than the Classic plan.  

The Saver plan is our more budget friendly option, it has good coverage, but is most notable for being very affordable. This plan has a $1,000 deductible. 

The Sharp Direct Advantage plan is a Medicare Part C plan that offers the excellent and still affordable coverage you can expect from most Part C plans. You can only enroll in this plan if you are retired and you qualify for Medicare.  

Confused about your choices surrounding Medicare? Check out this article.  

Medical Equipment  

Medical Equipment will be ordered from your doctor and will either be delivered to you or picked up from your doctor’s office.  

Classic Plan – $0 Copay  

Select Plan – 20% Coinsurance  

Saver Plan – 50% Coinsurance for durable medical equipment (after $1,000 deductible) 

20% Coinsurance for medical supplies (after $1,000 deductible) 

Sharp Medicare – $0 Copay, you may need medical authorization for certain supplies (e.g. therapeutic shoes)  

Depending on which Medical Group you’re a part of you will have a different vendor that supplies your medical equipment. See the list below for your medical vendors.  

Sharp Rees-Stealy’s vendor is Sharp Rees-Steely Pharmacy 

Sharp Community Medical Group uses Mini Pharmacy 

Greater Tri-Cities uses Advanced Diabetic Supplies 

Optum Care uses SG Homecare, Edgepark Medical, or Byram Healthcare 

Rady's/CPMG uses Advanced Diabetic Supply 

Medication 

Because there are different brands, generics, and options for diabetes management medication, there isn’t an exact answer to how much you’ll pay. So long as the medication is on the Sharp Health plan formulary and is prescribed by your doctor, you’ll pay one of the prices below. We know that there have been shortages and other issues affecting the price of many prescription drugs, be sure to talk with your pharmacy for pricing estimates before going to pick up or ordering medication for delivery.   

The Select and Saver plan have a brand deductible, this only applies to name-brand drugs when a generic is also available on the market. Be sure to talk with your doctor/pharmacy about this if you’re concerned. 

Classic Plan – $15-50  

Select Plan – $16-70 ($150 brand deductible)  

Saver Plan – $16-70 ($150 brand deductible) 

Sharp Medicare – Cost varies between $10 to $20 copay for 1 month supply. Some may have a $0 copay. Check Sharp’s Drug list for more details about specific covered medication.  

Doctor Visits 

Whether you’re getting a follow-up, referrals, or just checking up on something, going to the doctor can feel like a gamble. On one hand, you know you need help, but on the other, you might not know how much that help is going to cost. With each of our Sharp plans there is a clear copayment that you can expect from each doctor’s visit. There will be additional costs if you get a procedure, tests, or if the doctor’s office has something like a facility fee.  

You can always request a pre-treatment estimate or an insurance estimate from your doctor’s office before your appointment. We recommend this, especially when you’re going to see a new doctor.   

Note that the figures below only refer to in-network doctors.  

Classic Plan – $20 for PCP $20 for Specialist 

Select Plan – $20 for PCP $30 for Specialist 

Saver Plan – $20 for PCP $40 for Specialist ($1,000 deductible) 

Sharp Medicare – $10 for PCP $10 for Specialist ($0 for Diabetic Screening)