Does Medicare Cover Glucose Monitors
A glucose monitor can be an essential tool in managing Type 1 and Type 2 Diabetes. Depending on your diagnosis and treatment plan, your physician may recommend frequent monitoring throughout the day to make sure your sugar levels are within your target range. Glucose levels can fluctuate due to food or drink, physical activity, illness, stress, or even medications you take. Spikes in sugar levels can cause serious complications for diabetes patients, including organ damage, heart disease and kidney failure.
There are a variety of glucose monitors on the market that allow you to check your sugar levels at home, work, school, or while traveling. Most monitors come with lancets to prick your finger. Your blood is tested to determine your sugar level, based on milligrams per deciliter. According to the American Diabetes Association, the blood sugar level for someone with diabetes two hours after a meal should be less than 180 mg/dl, or between 80 and 130mg/dl after fasting.
Can Medicare Help Pay for Diabetes Supplies?
If you have been diagnosed with diabetes in the last year and your needs have changed, review your current coverage. If your plan no longer meets your needs, you can compare your options and enroll in a different plan during Medicares Annual Election Period, from October 15 through December 7.
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How Does Medicare Treat Durable Medical Equipment
Medicare treats glucose monitors and blood sugar test strips as durable medical equipment under Medicare Part B. If your physician prescribes glucose monitoring at home, your durable medical equipment costs are generally covered at 80 percent of the Medicare-approved
amount, once your deductible is met.
Keep in mind, however, that under Medicare Part B, your glucose monitoring equipment and supplies will only be covered if both your health care provider and DME vendor accept Medicare assignment. If you live in area affected by Medicares Competitive Bidding Program, you generally need to use a Medicare-contracted supplier.
What If I Need Therapeutic Shoes For My Diabetic Foot Pain
If you have diabetes and meet certain conditions, Medicare Part B covers therapeutic shoes when prescribed by your doctor. Medicare covers one pair of depth-inlay shoes and 3 pairs of inserts, or one pair of custom-molded shoes if you cant wear depth-inlay shoes. In some instances, Medicare may also cover separate inserts or shoe modifications instead of inserts.Medicare.gov, Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs, Accessed November 23, 2021
To qualify for therapeutic shoes your doctor must certify that you meet three conditions:Medicare.gov, Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs, Accessed November 23, 2021
Medicare also requires that a podiatrist prescribe the therapeutic shoes and that a qualified healthcare provider fits and provides the shoes.
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Medicare Coverage Of Glucose Monitors
Under Original Medicare , Part A covers health-care expenses you incur as an inpatient in a hospital, while Part B covers your outpatient care, including some glucose monitoring supplies and durable medical equipment. Medicare does not generally cover continuous glucose monitoring, which involves a sensor inserted under your skin for several days to a week.
If your health-care provider recommends a different way to monitor your blood sugar other than the finger-stick glucose monitor, you might want to check with Medicare to see whether its covered. You can reach a Medicare representative 24 hours a day, seven days a week, if you call 1-800-MEDICARE . TTY users can call 1-877-486-2048. If you have a Medicare Advantage plan, call your plan to ask about this coverage.
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.
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Does Medicare Cover Diabetes Screening
Medicare coverage is available to beneficiaries with high-risk for diabetes. Detecting diabetes in the earlier stages may prevent future health complications. Depending on your situation, you may be eligible for up to two screenings each year.
And, if your condition is chronic, talk to your doctor about Chronic Care Management covered by Medicare.
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How Does Medicare Pay For Blood Glucose Test Strips
If you have Medicare Part B , youll likely be covered for the costs of test strips.
Medicare covers blood glucose testing strips as a form of durable medical equipment. As such, Medicare will typically pay 80% of the costs of test strips.
However, that means certain costs will still be left up to you. These costs may typically include:
-
20% of Medicares approved costs of test strips
-
Any portion of Medicare Part B deductible that you havent yet paid
Some Medicare Part D prescription drug plans may also cover diabetes supplies, insulin and other medications.
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Are There Other Options For Medicare Coverage Of Glucose Monitors
Some Medicare beneficiaries choose to receive their Original Medicare benefits through the Medicare Advantage program. Part A covers hospice care when you have a Medicare Advantage plan. Medicare Advantage plans cover glucose monitors in the same way as Medicare Part B and often offer additional benefits, such as vision, dental, and prescription drug coverage. Some types of Medicare Advantage plans use provider networks, and may reduce the amounts you pay to monitor your glucose levels at home with a glucose monitor. In any case, when youre enrolled in a Medicare Advantage plan, youre still in the Medicare program, and must continue paying your Medicare Part B monthly premium, as well as any premium the Medicare Advantage plan may charge.
If you decide to stay with Original Medicare, another option you may have is to sign up for a Medicare Supplement plan to help pay for Original Medicares out-of-pocket costs for glucose monitors and other items and services. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.
Medicare Expands Coverage Of Diabetes Devices
Recent expansion of Medicare coverage for diabetes devices means millions of diabetes patients may have greater access to more affordable means of managing the disease.
Medicare will now cover a continuous glucose monitor that doesnt require diabetes patients to prick their fingers. And the Centers of Medicare and Medicaid Services also will now cover more innovative insulin pumps for diabetes patients.
New Coverage for Glucose Monitoring
Abbott Laboratories FreeStyle Libre System, which allows continuous blood sugar level monitoring without having to draw blood through a finger prick, was approved by the U.S. Food and Drug Administration in September, but its usage has been somewhat limited as it awaited approval by insurance companies and the CMS. The decision in January by the CMS, which oversees the federal health programs of Medicare and Medicaid, expands the coverage to millions of diabetes patients.
The FreeStyle Libre Flash is the second continuous glucose monitoring system after DexCom Incs G5 Mobile that the federal agency has covered.
New Coverage Possible for Some Insulin-Delivery Devices
Modern Healthcare reported on the under-the-radar notice issued in early January by the CMS that Part D sponsors can now cover new products that deliver insulin through the skin directly, rather than through a catheter placed under the skin.
CMS is not requiring Part D sponsors to include them in their formularies, however.
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What Brand Of Diabetes Supplies Is Covered By Medicare
There are a number of brands of diabetes supplies that are covered by Medicare, specifically:
- OneTouch
- Abbotts
- Bayer
However, not all brands are covered by Medicare, so check your coverage before purchasing any supplies. You can ask your doctor, pharmacist or supplier to check for you, or contact Medicare directly.
Medicare Eligibility For A Therapeutic Cgm
A therapeutic CGM is a medical device approved by the U.S. Food and Drug Administration as a replacement for home blood sugar monitors. It provides you and your doctor with the medically necessary information to make diabetes treatment decisions, such as changes in diet and your insulin dosage.
To qualify for a therapeutic CGM, you must be undergoing treatment for diabetes and meet certain other criteria.
To be eligible for a therapeutic CGM under Medicare, you must meet the following requirements.
- You are using insulin to treat Type 1 or Type 2 diabetes.
- You need to check your blood sugar four or more times per day.
- You must use an insulin pump or receive three or more insulin injections per day.
- You must make routine, in-person visits to your doctor.
- Your doctor has determined that you meet all Medicare eligibility requirements.
The decision between a therapeutic CGM or a traditional monitor is one you should make after talking to your doctor. A therapeutic CGM may be a better option if you use insulin and frequently change your dosage.
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Are Additional Diabetic Supplies Covered By Medicare
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.
Does Medicare Pay For Cgm Accessories And Supplies
Yes, Medicare generally pays 80% of the cost of CGM accessories and supplies. Under the guidelines, Medicare Part B covers:
- Patch refills based on the recommended replacement schedule. For example, if you use a CGM that requires a new patch every 14 days, Medicare will pay for two patches every 28 days.
- Up to 300 test strips every three months if you are being treated with insulin
- Up to 300 lancets every three months if you are being treated with insulin
Medicare Part D may also cover:
- Alcohol swabs
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New Medicare Coverage Requirements Make Cgms More Accessible
The diabetes community is celebrating a huge win! Beginning on July 18, 2021, Medicare will permanently eliminate the requirement of the four-time-daily fingerstick in order to qualify for coverage of a continuous glucose monitor .
This requirement was an unnecessary barrier for Medicare beneficiaries, delaying access to this effective technology for individuals with diabetes.
CGMs provide users with real-time, dynamic information about their blood glucose levels around the clock and alerts to prevent dangerous high or low glucose levels, leading to better diabetes management and ultimately improved health outcomes. One out of five people on Medicare have diabetes, and the elimination of the fingerstick requirement means Medicare beneficiaries with diabetes will have easier access to this critical technology.
What does this mean for you? If you already have coverage for your CGM, great! If youre looking to get one and receive your health insurance through Medicare, after July 18 there will be a simplified, fingerstick-free approval process. The out-of-pocket cost for your CGM will depend on a few factors, like what your Medicare benefit plan looks like, where youll get your device, etc. Talk to your doctor and a Medicare representative to determine what it will cost for you.
Medicare Part B Covered Diabetes Testing Supplies
Part B covers a number of blood sugar self-testing supplies and equipment, even if you dont use insulin. These include:
- Blood sugar monitors
- Lancet devices and lancets
- Glucose control solutions
These supplies are considered durable medical equipment, and the actual amount of supplies that are covered varies depending on whether or not you use insulin. For example, if you use insulin, you may be able to get up to 300 test strips and 300 lancets every three months, but if you dont use insulin you may only be able to get up to 100.
If your doctor says its medically necessary, Medicare will cover additional test strips and lancets.
Test strips can be used to help monitor certain substances in the blood. They are small, single-use pieces of paper-like substance that you place one or two drops of blood on, and insert into a testing device. These devices provide results within seconds, and you can address any concerns regarding blood glucose levels.
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How Can I Get An Affordable Continuous Glucose Monitor
People who arent eligible for a continuous glucose monitor through Medicare may still be able to access an affordable device. Start by checking your health insurance to see if monitors are covered.
If you cant get a monitor through health insurance, you can try contacting the manufacturers. Many companies offer financial assistance to qualifying customers to help them access monitoring technology, including free trials and ongoing discounts for supplies.
Speak to your doctor if you want to try a continuous glucose monitor. Some doctors have stocks of supplies that theyre willing to share, and clinics may have professional continuous glucose monitors that they loan out. These are used for a short time to get a snapshot of your glucose data and gauge the effectiveness of your diabetes management.
Finally, you can look for an affordable supplier. More monitoring systems are becoming available through pharmacies, and these are generally less expensive than ordering direct through manufacturers.
How Does Medicare Cover Diabetic Supplies
Medicare Part B covers a wide range of diabetes testing supplies, including:Medicare.gov, Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs, Accessed November 23, 2021
- Blood sugar monitors
- Lancet devices and lancets
- Glucose control solutions used to verify test equipment accuracy
Medicare covers the testing equipment and supplies listed above whether you use insulin or not. However, the number of supplies covered by Medicare Part B varies:Medicare.gov, Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs, Accessed November 23, 2021
If your doctor determines that its medically necessaryServices or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice…., and completed the required documentation, Medicare will cover additional test strips and lancets. If you meet the necessary criteria, Medicare will cover a therapeutic continuous blood glucose monitor and related supplies.Medicare.gov, Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs, Accessed November 23, 2021
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Will Medicare Cover My Diabetic Shoes And Inserts
If you have certain medical conditions related to your diabetes, such as severe diabetic foot disease, Part B might cover one pair of depth-inlay or custom-molded shoes each year and up to three pairs of inserts each year. You generally pay 20% of allowable charges plus any applicable deductibles.
Part B may also cover the professional fees of the podiatrist or other doctor who prescribes the shoes and of the health-care provider who fits them, up to allowable amounts, less your coinsurance and applicable deductibles.
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Lifescan Onetouch Products Only Covered Products Starting January 2016
Home > What’s New > News > Important Updates > Latest News > 2015 News > LifeScan OneTouch products only covered products starting January 2016 LifeScan OneTouch products only covered products starting January 2016 At Independent Health we are committed to improving the care of diabetic patients and providing physicians with important information that supports efforts to provide appropriate, safe and cost-effective therapy. Following a comprehensive review of the available blood glucose monitoring systems, test strips and supplies, Independent Health and its Pharmacy and Therapeutics Committee have determined that LifeScans OneTouch blood glucose meters and its test strips will be the preferred diabetic testing products for Independent Health commercial and Medicare members, effective January 1, 2016. Members currently using other brands of blood glucose meters will be able to order a OneTouch Blood Glucose Meter at no charge. All other brands of test strips will require prior authorization. Independent Health will cover only these meters as of 1/1/16 Independent Health will cover only these test strips as of 1/1/16Continue reading > >
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Where Do I Go For My Diabetic Supplies
You can order and pick up your supplies at your local pharmacy or through a durable medical equipmentDurable medical equipment is equipment that is designed to last and can be used repeatedly. It is suitable for home use and includes wheelchairs, oxygen equipment, and hospital beds…. supplier. Keep in mind that you must order refills for your supplies. Also, your doctor must renew your prescription every 12 months.Medicare.gov, Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs, Accessed November 23, 2021
Medicare will not allow you to submit a claimA request for payment that you submit to Medicare or other health insurance when you get items and services that you think are covered…. for a blood sugar monitor or test strips yourself. All Medicare-enrolled suppliers must submit a claim for blood sugar monitors, test strips, and other items covered under Medicare Part B.Medicare.gov, Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs, Accessed November 23, 2021
