Does Medicare Cover Continuous Glucose Monitors
Original Medicare covers continuous glucose monitors through Part B of Medicare. In most cases, Medicare covers the monthly supplies for a monitor, which is a combination of sensors, transmitters and batteries depending on the brand. Although devices are covered, beneficiaries may have to pay copays or deductibles.
As Medicare Advantage must provide the same level of coverage as Original Medicare, these devices are also available to people on Medicare Advantage Plans. However, individual Medicare Advantage Plans may have different rules around costs, brands and the choice of where you can get services.
In the past, continuous glucose monitors were considered precautionary instead of medically necessary, which limited the number of people who could gain access to the technology. However, rules changed in 2021, allowing more enrollees to benefit from the devices.
What Are The Key Differences Between The Medicare Version Of Freestyle Libre And G5
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.
Medicare Covers Some Other Diabetes Supplies And Treatments
Medicare Part B also helps cover the costs of some other diabetes treatment-related services, which can include:
Lancets and lancet devices
Blood sugar monitoring and control devices
Therapeutic shoes or shoe inserts
Its important to note that in order for Medicare to cover some diabetes testing supplies, you may need to go through specific durable medical equipment suppliers who are enrolled in Medicare.
Additionally, Medicare Part B covers some diabetes services. These can include:
Annual eye exams
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Indiana Medicaid For Members
Beginning January 1, 2011, a Preferred Diabetic Supply List will be implemented. You will need to start using one of the blood glucose monitorslisted in the table below. If you have a blood glucose monitor thatis not on the list below, you will need to speak with your doctorto get a new prescription for one of the blood glucose monitors andtest strips listed below. New blood glucose monitors and teststrips will be provided at no cost to you. If you alreadyhave one of the blood glucose monitors listed below, you do notneed to do anything. What if I need a monitor not on this list? If you have a medical condition that prevents you from using oneof the blood glucose monitors listed above, you or your pharmacywill need to speak with your doctor and ask him to request a priorauthorization for a different blood glucose monitor and teststrips. You may continue to use the same provider for your diabeticsupplies as you do now, and you will continue to receive theseproducts at no charge to you. If you have questions about this change, please contact theIndiana Health Coverage Programs Members Hotline at1-800-457-4584. If you have questions about any of the products on the PDSL,please contact the manufacturer for that product .The Abbott Diabetes Care Product Support Line and Roche DiagnosticsCustomer Care Center are available 24 hours a day, seven days aweek for product assistance.Continue reading > >
Cms Expands Medicare Coverage For All Cgms
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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.
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Medicaid And Cgm: Who’s Covered
Continuous glucose monitoring coverage varies widely by state Medicaid program check out our guide on whos covered and where
In California, a staggering 25% of the population is covered under Medi-Cal and the Childrens Health Insurance Program , which are programs for low-income Americans supported by federal and state governments. We estimate that at least half of these beneficiaries have diabetes, prediabetes, or undiagnosed diabetes. For these individuals, coverage of diabetes drugs and technology dramatically increases their chances of living a life free of complications. Despite this, however, continuous glucose monitors are not covered by Medi-Cal. Moreover, while CGMs are covered under California Childrens Services , a state program for children with certain diseases or health problems, this is limited only to children with multiple co-morbidities and children who are disabled.
CGM is already covered by most private insurance and recently became covered under Part B of Medicare, a federal health insurance program that covers those who are 65 or older or who are disabled. The importance of providing CGM to those who will benefit from it is clearly understood, as acknowledged by Medicares choice to provide coverage. It seems clear that these benefits should be made available to low-income individuals on Medicaid, and many in the advocacy community are working to ensure progress is made on this front.
Therapeutic Continuous Glucose Monitors
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.
If you use insulin and require frequent adjustments to your insulin regimen/dosage, Medicare may cover a continuous glucose monitor if your doctor determines that you meet all of the requirements for Medicare coverage.
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Medtronics New Access Program Provides Discounted Cgm To Those Without Coverage
The CGM Discount Access program provides discounted rates on the Guardian Sensor 3 continuous glucose monitoring system for people without insurance coverage for Medtronic CGMs.
Medtronic recently launched its CGM Discount Access program which provides the Guardian Sensor 3 continuous glucose monitor at a discounted price to people who meet the eligibility criteria. Specifically, the program provides a Guardian Link 3 transmitter with a 12-month warranty for $180 and a monthly supply of five Guardian Sensor 3 sensors for $60 per month.
To be eligible for the program, people must:
Use multiple daily injections of insulin or be on insulin pump therapy
Have a valid CGM prescription from a healthcare professional
Not have insurance coverage for a Medtronic CGM
People on Medicare are also eligible for the CGM Discount Access program, as Medicare does not currently cover Medtronics CGM system. It should be noted however, that the Centers for Medicare and Medicaid Services recently proposed new rules that would allow for reimbursement of Medtronics Guardian CGM. If approved, the changes would go into effect on April 1, 2021.
These programs have become increasingly important, especially since people with diabetes face more severe financial hardship during the pandemic. Read more about how COVID-19 has affected the diabetes community here.
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More Cgms Now Covered By Medicare
In March 2022, Medicare beneficiaries became eligible for coverage for a greater number of CGMs than ever before. Due to a final rule issued on December 21, 2021 by the Centers for Medicare and Medicaid Services , any CGM that connects with an insulin pump or a standalone receiver will be covered by Medicare for anyone otherwise eligible. This rule took effect at the beginning of this month, so people with Medicare now have access to Dexcom G6, Abbott Freestyle Libre, Senseonics Eversense and Medtronic Guardian, as long as these CGMs are used with an insulin pump or with use of a standalone receiver.
Previously, CMS only covered therapeutic CGMs which are those devices approved by the Food and Drug Administration to make insulin dosing decisions. This expansion means that people on Medicare with diabetes will now have access to a broader choice of CGMs similar to what is available to those with commercial insurance.
In July 2021, CMS announced that people with diabetes no longer needed to prove that they are testing their blood sugar at least four times per day with a blood glucose meter to get initial Medicare coverage for a CGM device. Additionally, language was clarified to allow individuals using inhaled insulin, not just injected insulin, to access CGM. To read more about this, read our blog post here.
All of these recent changes are long-sought advocacy goals for JDRF and welcome news for members of the T1D community.
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 magazine. She is on Twitter @MiriamETucker.
What Are Continuous Glucose Monitors
Continuous glucose monitors are devices that let you check your blood sugar without having to collect a blood sample each time. To use one, you insert a patch into the skin on the back of your arm. Sensors in the device track your blood sugar levels continuously. When you want to see your number, you hold a receiver up to the patch. Some CGMs have an app that turns your smartphone into a receiver. The app also stores your readings and can send them to your doctor if you wish.
CGMs offer many benefits, including:
- Reduced need for finger sticks
- Greater accuracy, as the devices are not typically affected by over-the-counter medications
- Easier tracking with mobile app
- Fewer low blood glucose emergencies because many devices warn you of out-of-range readings with alarms
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What Does Medicare Cover For Diabetics
If you have diabetes, you know its a day-to-day reality that needs to be attended to. It can feel like a full-time job, but you dont have to do it alone.
Medicare covers various diabetes medications, supplies and services to help treat diabetes and keep your blood glucose in a healthy range.
- Medicare Part B covers blood glucose testing and other supplies you may need, plus some medical and education services
- Medicare Part D covers diabetes medications and supplies for injecting or inhaling insulin
Heres a rundown of the diabetes supplies and services that Medicare covers. Some require a prescription or recommendation from your doctor. Coverage limits may include the amount of some supplies you can get or how often some services are covered.
What Glucose Monitor Is Covered By Medicare
Not every glucose monitor is covered by Medicare. Several CGM systems that contain glucose monitors are available for beneficiaries. They include:
- Freestyle Libre
If you have Medicare Part C, your plan may cover additional glucose monitors. Each plan varies, so make sure to check before you buy. In many instances, you will need preapproval from your plan or Original Medicare before purchase.
What extra benefits and savings do you qualify for?
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Who Qualifies For A Continuous Glucose Monitor
Medicare will cover CGMs for people who:
- Have an established diagnosis of Type 1 or Type 2 diabetes
- Are currently using a traditional blood glucose monitor
- Must check their blood sugar a minimum of four times daily
- Use insulin to treat diabetes and require frequent adjustments to their regimens or have a subcutaneous insulin infusion pump
- Receive training from their doctors on how to use CGMs
How Do I Get Medicare To Cover A Cgm
For Medicare to cover the cost of FreeStyle Libre, you must:
- Continue to pay your Part B premium
- Have already paid your Part B deductible
- Receive a prescription for the device from a physician who accepts Medicare
- Buy the CGM from a supplier who accepts Medicare
- Cover whatever portion of the costs that Medicare doesnt
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Does Medicare Cover Therapeutic Continuous Glucose Monitors
Yes! Continuous Glucose Monitoring Systems are covered by Medicare for patients who meet the Medicare coverage criteria. Medicare patients who have either type 1 or type 2 diabetes and manage their insulin therapy may be able to obtain a therapeutic CGM if the following Medicare coverage criteria is met:
- The patient has diabetes
- The patient uses three or more daily administrations of insulin or an insulin pump
- The patients insulin treatment regimen requires frequent adjustments based on BGM or CGM testing results
- Within six months prior to ordering the CGM, the patient had an in-person visit with the treating practitioner to evaluate their diabetes control and determine that the above criteria have been met and
- To remain eligible, the patient must have an in-person visit with his/her treating practitioner every six months to evaluate adherence to their CGM therapy and diabetes treatment plan.
- For a full description of coverage criteria,
DO YOU QUALIFY?
Medicare does not cover CGM supplies that are used ONLY with a smartphone or other mobile device. Therefore, you must use a receiver to view your glucose data.
Coverage of Continuous Glucose Monitor system supplies and accessories are available for those therapeutic CGM systems where the beneficiary uses a receiver classified as DME to display glucose data. There is no Medicare benefit for supplies used with equipment that is not classified as DME.
Looking Backand Forwardson Cgm Access For T2d
Fortunately, you no longer need to prove that you check your blood sugar four times a day, explains Marchand Aprigliano, who has been advocating for people with diabetes, access to care and technology and affordable insulin.
This was a huge win for the diabetes community in the summer of 2021.
It wasnt until 2017 when CGMs were covered for those on Medicare at all.
But then we immediately had to fight for coverage to use a smartphone to view your CGM readings, explains Marchand Aprigliano.
In 2018, using a smartphone with your CGM was approved, explained DiabetesMine.
All you should need to get a CGM is a diagnosis of diabetesany type of diabetes, says Marchand Aprigliano.
Educational content related to CGMs for type 2 diabetes is made possible with support from Dexcom. Beyond Type 2 maintains full editorial control of all content published on our platforms.
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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.
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