Sunday, May 22, 2022

Does Medicare Cover Continuous Glucose Monitoring Systems

Don't Miss

What Are The Key Differences Between The Medicare Version Of Freestyle Libre And G5

Dexcom G6 Medicare Patient Coverage

These product differences will change over time some potentially this year. For instance, Dexcoms next-gen G6 is currently under FDA review, with plans to launch before the end of 2018. It is currently under review for one fingerstick calibration per day and 10-day wear, but FDA discussions are also underway for a no-calibration version. Meanwhile, Dexcoms next-next-gen sensor with Verily requires no calibration, will be fully disposable, and last 10 or 14 days. Abbott is currently developing a next-gen FreeStyle Libre as part of its Bigfoot partnership, which will add continuous communication to the FreeStyle Libre sensor. Wed guess it could add alarms too, but this is speculation on our part.

Which Cgm Devices Are Covered By Medicare

The Dexcom G5 was one of the first of the CGM devices to be FDA approved as a therapeutic CGM in 2017, which qualified the device for Medicare coverage. As with most other technology, diabetes technology continues to evolve, and newer products have since followed suit, including those manufactured by Abbott, Medtronic, and others.

Currently, Aeroflow offers the Dexcom G6, the FreeStyle Libre 14 Day System and the FreeStyle Libre 2, all eligible for Medicare coverage. The Dexcom devices are typically worn on the skin of the torso for up to 10 days, where a water resistant sensor can measure and transmit blood glucose readings every few minutes to a reader or a smartphone app. The FreeStyle Libre is a line of continuous glucose monitors that are typically worn on the skin of the upper arm for up to 14 days. Unlike the Dexcom, the FreeStyle is a flash glucose monitoring system, meaning that while it continually measures blood glucose levels, it only transmits this to a reader when scanned. Each has its own set of unique features, alarms, and recommended age range.

New Cgm Coverage For Medicare Customers

We know that for those with Medicare coverage, its been long awaited to have the Medtronic integrated continuous glucose monitor covered, and were thrilled to announce that the wait is over. Medicare has officially expanded to include CGMs that integrate with Medtronic insulin pumps.

This is a very important benefit expansion for our customers who have experienced the benefits from their integrated Medtronic insulin pump systems and are now able to receive coverage for all components of their system on Medicare Jeff Farkas, Vice President of Health Economics, Reimbursement, and Government Affairs for Medtronic Diabetes.

Wherever you are on your diabetes journey, were here to support you. Were excited that this expanded coverage will open new opportunities for our valued customers like Terry.

Ive experienced tremendous benefits from integrated pump therapy, and Im thrilled that this opens up access for many more people looking for ways to enhance their diabetes management. Terry, Medtronic Diabetes Ambassador*.

For those currently on a Medtronic integrated CGM:

For customers who are using the CGM Access Discount program, orders placed on or after February 28, 2022 will now go through your Medicare coverage. To keep your next sensor order running smoothly, wed like to discuss changes in the price and make sure we have everything thats needed.

Benefits of CGM:

New to Medicare?

Read Also: How Do I Cancel Medicare Part A

Would You Like To Know More About Medicare Coverage Of Glucose Monitors

If you have questions about Medicare coverage for home glucose monitors, or would like more information about Medicare plan options to help you better plan for your expenses, Id be happy to discuss them with you. If youd like to schedule a phone call, or request a personalized email, click on the corresponding button below. The Compare Plans button on the page will show you some of the Medicare plan options available in your area.

The product and service descriptions, if any, provided on these Medicare.com Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

New To Medicare?

Becoming eligible for Medicare can be daunting. But don’t worry, we’re here to help you understand Medicare in 15 minutes or less.

Superior Medicare Patient Coverage

Dexcom G5 CGM System is now covered under Medicare ...

Advanced Diabetes Supply has specialized and created a unique expertise in working with Medicare patients and beneficiaries. Advanced Diabetes Supply was the first Medicare distributor to have obtained Medicares required DMEPOS Accreditation. We continue to lead the industry, honing our processes and understanding of Medicare, its coverage and coverage requirements.

Don’t Miss: How To Order Another Medicare Card

Does Medicare Pay For Dexcom Cgm

DexcomMedicareMedicare coverageMedicare coverageCGM

. Herein, does Medicare pay for continuous glucose monitor?

Medicare covers therapeutic continuous glucose monitors and related supplies instead of blood sugar monitors for making diabetes treatment decisions, like changes in diet and insulin dosage.

Secondly, how much does a Dexcom CGM cost? For those paying retail, cash price: Box of sensors: $349 Two transmitters: $475 per bundle

Simply so, does Medicare pay for dexcom g6?

Dexcom G6® CGM System will be covered for Medicare beneficiaries, having met the category requirements for therapeutic CGM systems by the U.S. Centers for Medicare& Medicaid Services .

How much does Medicare cover for dexcom?

A: According to Dexcom’s Medicare FAQ page, those covered by Medicare can expect to pay 20% of the costs of their G5 CGM, which is roughly $50 per month. Medicare will cover the remaining 80%.

What Brand Of Glucose Meter Is Covered By Medicare

There are several options for CGM devices that are covered by medicare. In addition, there are other diabetes supplies that are covered through Medicare, either partially or fully. As this can change from year to year, its worth checking out the Medicare website for questions about coverage.

You can also check out Medicares Coverage of Diabetes Supplies, Services & Prevention Programs. Not only does it have information about what Medicare covers, but also lets you know where you can find more information so you can make the best decisions regarding your health.

Read Also: How Much Does Medicare Pay For Knee Replacement

Medicare To Cover Therapeutic Cgm Sets Criteria

For Medicare patients on continuous glucose monitoring , the news is good. The Centers for Medicare and Medicaid Services will cover therapeutic continuous glucose monitoring , and have set the criteria that must be met. In the past, it has not been covered.

CMS announced the criteria decision March 23, following their January ruling about granting coverage for CGM. 1

The coverage decision is a game changer for our Medicare patients, says Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDE. She is program coordinator for the Teen and Adolescent Diabetes Transition Program at the University of Chicagos Kovler Diabetes Center and a member of the editorial board for EndocrineWeb.

The decision is long overdue, says J. Michael Gonzalez-Campoy, MD, PhD, medical director and CEO of the Minnesota Center for Obesity, Metabolism and Endocrinology in Eagan, MN, and a member of the editorial board for EndocrineWeb. The medical literature clearly documents that enhanced monitoring improves outcomes in the treatment of diabetes.

The coverage is effective for service dates Jan. 12, 2017 and later, according to CMS.

Read Also: Does Medicare Help Pay For Incontinence Supplies

Discover The Benefits Of Continuous Glucose Monitoring Systems

Dexcom CGM Overview Video for Healthcare Providers

Because your blood glucose levels are visible continuously with CGM, you can see how various activities affect you and then make immediate adjustments. Testing with CGM can also warn about impending highs and lows and can help improve your A1c level. Our specialists can help you learn more about Continuous Glucose Monitoring Systems and find out if it is right for you.

Certified Diabetes Care & Education Specialists are available to answer your questions about glucose testing, blood sugar levels, nutrition, and exercise.

REORDER NOW

Recommended Reading: Do I Qualify For Medicare If I Am Disabled

Are There Costs Outside Coverage

Different parts of Medicare will provide coverage for FreeStyle Libre. However, a person may have additional out-of-pocket costs, and they will also have to pay for replacement sensors.

Costs for FreeStyle Libre vary, and a person may wish to check prices from various Medicare-approved suppliers using this information. According to the manufacturers, a person with private insurance will pay a monthly average of between $10 and $75 for two FreeStyle Libre 14-day sensors.

What Are The Qualifications For Medicare Coverage For Cgms

Under the guidelines established by Medicare, the following statements must apply to you to qualify for coverage for a CGM:

  • You have an established diagnosis of diabetes.
  • You are currently using a blood glucose monitor.
  • Your doctor recommends that you check your blood sugar four or more times every day.
  • You use insulin to control diabetes, and your regimen needs to be adjusted regularly.
  • You have been seeing the doctor who will prescribe the CGM for at least 6 months.
  • Your doctor has taught you how to properly use the device.

For coverage to continue, you will need to see the prescribing doctor for checkups every 6 months. In addition, you must use the receiver to display your glucose readings. You may use the smartphone app in addition to the receiver to review data or send readings to your medical provider however, you cant only use your smartphone. This rule exists because a smartphone is not classified as durable medical equipment.

Also Check: Is Root Canal Covered By Medicare

Recommended Reading: Do I Have Medicare Part B

Does Medicare Cover Dexcom G6

Glucose monitoring technology, including continuous glucose monitoring systems, plays a vital role in protecting the health of individuals who suffer from issues related to blood sugar and insulin production. In the past, individuals who needed to check their blood glucose levels would typically need to obtain a blood sample, often through a prick on the finger, and the sample would then need to be manually inserted into a testing device for analysis. Unfortunately, this method can be time-consuming, and it relies on the user remembering to take measurements at various times throughout the day. This could also mean missing regular testing during the night due to sleep.

Today, however, advanced glucose monitoring using technology like the Dexcom G6 can provide real-time data 24 hours a day for people who need continuous monitoring. Modern monitoring provides important information regarding overall health as it relates to glucose levels, allowing for faster treatment in the event of an emergency. This is vital for patients who are diabetic or for patients who may be at risk for developing health conditions related to fluctuating or uneven blood glucose.

Related articles:

Are Additional Diabetic Supplies Covered By Medicare

Medicare to Cover Glucose Monitoring on Smartphones

Additional diabetic supplies are covered by Medicare, including test strips, traditional blood glucose meters, lancets and control solutions. Therapeutic shoes may also be available to people who have foot problems caused by diabetes.

Insulin and other glucose-controlling medications may also be available through Medicare but only through prescription drug coverage. To access prescription drugs, you must either get Medicare Part D or a Medicare Advantage Plan that includes prescription medications.

Also Check: Is Medicare The Best Insurance

Cms Expands Medicare Coverage For All Cgms

We were unable to process your request. Please try again later. If you continue to have this issue please contact .

CMS will expand Medicare coverage for all types of continuous glucose monitors, including adjunctive and non-adjunctive CGMs.

The final rule, issued Dec. 21, classifies adjunctive CGMs under the Medicare Part B benefit for durable medical equipment and finalizes certain DME payment provisions that were included in two interim final rules. It will be effective starting 60 days after official publication.

The Durable Medical Equipment, Prosthetics, Orthotics and Supplies final rule aligns with the key goals of the administration to create a health care system that results in better accessibility, quality, affordability, empowerment and innovation, CMS stated on its web site.

In a fact sheet, noted it is not finalizing the proposed categories of supplies and accessories and fee schedule amounts for three types of CGM systems.

After consideration of public comments, CMS does not believe it is necessary at this time to further stratify the types of CGMs beyond the two categories of non-adjunctive and adjunctive CGMs, the agency stated. The fee schedule amounts for the newly covered adjunctive CGMs and related supplies and accessories will be established in accordance with existing regulations for establishing fee schedule amounts for new durable medical equipment items and services without a fee schedule pricing history at 42 CFR 414.238.

Reference:

The Role Of Healthcare Professionals

From the healthcare professionals perspective, CGM is often a cost burden and inaccessible for people who are underinsured, have lapses in health plans or new deductibles, or cant get CGM covered due to not yet meeting insurance requirements, says diabetes care and education specialist in Ohio.

Its more accessible now, though.

Blanchette says commercial insurers have loosened requirements, such as the 60 to 90 days of blood sugar logs they once mandated to approve a CGM. She says Medicaid in her state of Ohio eliminated any logbook requirement. But Medicaid still only covers CGM for people requiring insulin, taking at least 3 injections per day, or using insulin pump therapy.

Blanchette, who also lives with T1D, says she faces CGM affordability struggles herself too. That helps inform how she talks with people about this technology.

I struggled to pay for very costly CGMs over the past few years. I maxed out my flex spending and found other ways to pay for the high cost, like charging my credit card until I could pay, she says.

CGM is trying to move towards the pharmacy model, which will save people a lot on monthly payments. For people with high costs through durable medical equipment suppliers, I encourage them to look into changing over to the pharmacy. This is successful and much cheaper in some cases but definitely not in all situations.

Read Also: What Do You Need To Sign Up For Medicare

Costs Before And After Coverage

Before the Medicare coverage, ”a typical patient would spend $2500 to $4000 a year,” Sayer says. That includes the cost for the transmitter, about $800 to $1000 a year, and sensors.

Dexcom’s G5 Mobile has an externally worn glucose sensor that measures blood sugar levels continuously. It displays the values every five minutes. A small, flexible metal wire or sensor is inserted just below the skin, generating a small electrical signal in response to the amount of sugar there. The signal is converted to a glucose reading.

About 98% of commercial payers have coverage for CGM, Sayer says. Patients typically pay a copay of about 20%, he says.

The turning point for the Medicare coverage, he says, came with the FDA approved label change allowing consumers to make dosing decisions based on the therapeutic testing results with the CGM.

For the older adult population, Sayer says, ”the sensor is giving you a tool that the body loses. Your body loses the ability to detect the low , some more than others.”

Home Blood Glucose Monitors

Medicare Now Covers Continuous Glucose Monitors!

Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

CIM 60-11

There are several different types of blood glucose monitors that use reflectance meters to determine blood glucose levels. Medicare coverage of these devices varies, with respect to both the type of device and the medical condition of the patient for whom the device is prescribed.

Reflectance colorimeter devices used for measuring blood glucose levels in clinical settings are not covered as durable medical equipment for use in the home because their need for frequent professional re-calibration makes them unsuitable for home use. However, some types of blood glucose monitors which use a reflectance meter specifically designed for home use by diabetic patients may be covered as durable medical equipment, subject to the conditions and limitations described below.

  • The patient has been diagnosed as having diabetes
  • The patients physician states that the patient is capable of being trained to use the particular device prescribed in an appropriate manner. In some cases, the patient may not be able to perform this function, but a responsible individual can be trained to use the equipment and monitor the patient to assure that the intended effect is achieved. This is permissible if the record is properly documented by the patients physician and
  • The device is designed for home rather than clinical use.
  • Don’t Miss: Is There An Income Limit For Medicare

    Does Medicare Cover Continuous Glucose Monitors

    • Get the facts about Medicare coverage of continuous glucose monitors . Find out who qualifies for CGMs and how much you can expect to pay out of pocket.

    The U.S. Centers for Disease Control and Prevention advises that regular blood sugar monitoring can improve the effectiveness of treatments for Type 1 and Type 2 diabetes and lower the risk of serious complications like blindness, heart attack and stroke. Continuous glucose monitors make it easier to keep tabs on your blood sugar levels throughout the day, and the most popular models are often covered by Medicare.

    What About Medicare Coverage For Those Not On Intensive Insulin Therapy

    At this time, Medicare coverage is only available to those that meet the criteria above. We feel very strongly that others at risk of hypoglycemia, especially those on sulfonylureas , should also have access to CGM. We will be working on advocacy on this front if youd like to help.

    If you have other questions on Abbotts FreeStyle Libre, Dexcoms G5, and Medicare coverage,

    Don’t Miss: What’s Wrong With Medicare Advantage

    Medicare Expands Coverage Of Continuous Glucose Monitoring Devices For Diabetes

    Miriam E. Tucker

    The Centers for Medicare & Medicaid Services has finalized a rule to expand Medicare coverage to include continuous glucose monitoring devices that are not approved for making treatment decisions.

    Proposed in November 2020, the final CMS rule applies primarily to CGMs that integrate with Medtronic insulin pumps. Those CGMs have not been approved by the US Food and Drug Administration to replace the need for fingerstick blood glucose measurements in determining insulin or other glucose-lowering medication dosing.

    Other CGM systems, Dexcom G6 and Abbott Libre, have “therapeutic” indications and were already covered under Medicare, as was the combined insulin pumpCGM Tandem Diabetes Care Control-IQ technology system.

    The expanded coverage means that people using the Medtronic 770G or 630G hybrid closed-loop insulin delivery systems will receive coverage for all the systems’ components, and that people aging into Medicare won’t lose any coverage for those devices.

    Medtronic will continue to offer its CGM Access Discount to all Medicare customers until the ruling takes effect. The proposed rule was finalized on December 21, 2021, and will be effective starting 60 days after official publication.

    Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR’s Shots blog, and Diabetes Forecast

    More articles

    Popular Articles