Does Medicare Pay For Glucose Monitors?

Continuous Glucose Monitors (CGM’s) are life savers for many insulin dependent diabetics. Medicare does cover diabetic supplies and medications but it is the way those items are covered that can be confusing. Not all diabetics need a pump. Not all diabetics that need a pump need a CGM. Some are able to manage their disease with either oral medication or by injection.

CGM Continuous Glucose Monitor CGM

If your doctor certifies to Medicare that you meet their criteria for an insulin pump then maybe Medicare will cover the device.

Or maybe they won’t.

And Medicare might pay for some glucose monitor’s but not for others.

Confused?

Read on.

 

CGM’s and Medicare

A CGM can be an insulin pump but not all insulin pumps are CGM’s.

In insulin pump is an implantable device used to administer insulin rather than using a syringe and needle. Pumps can be programmed to release small doses of insulin in much the same way as your pancreas does. By delivering “mini” doses of medicine the need for long acting insulin is eliminated.

A Continuous Glucose Monitor continuously measures your glucose levels but not your blood glucose levels.

Medicare covers therapeutic CGM’s but not adjunctive CGM’s.

 

Medicare Part B and Part D

Insulin is covered under Medicare Part D (drug plans) unless it is covered by Part B.

Screening for diabetes is covered by Medicare Part B . . . unless you need more than two screenings per year.

Medicare Part B pays for glucose monitors, lancet’s, test strips and most other Durable Medical Equipment (DME) but they do limit the quantity and how often you can get these supplies.

If you use insulin Medicare covers up to 300 test strips and lancets every 3 months. But if you do not use insulin Medicare covers up to 100 test strips and lancets every 3 months.

Apparently Medicare believes you do not need to test your blood sugar as often if you are not insulin dependent.

Medicare Part D covers insulin unless it is covered by Part B.

Medicare may pay for Continuous Glucose Monitor sensor’s but only if your monitor is a specific brand. Sensors are devices planted under the skin to monitor and relay information about your glucose levels.

Medicare has approved the Dexcom G5 CGM but only if you use the receiver that comes with your device but not if you use a smart phone app.

Do you really think Medicare will track everyone who has a Dexcom G5 to see if they are checking their glucose on their smart phone? And why should Medicare care if you use your smart phone or not?

Medicare Advantage or Medicare Supplement

If you have a Medicare Advantage plan in many cases your plan will pay 80% of the cost of your pump or CGM and you will pay the remaining 20%. Monitors run anywhere from $1000 to $1400 plus another $300 or so each month for sensors. And you will need a battery that is changed about once a year or so. They run around $500.

With an Advantage plan your out of pocket costs can get expensive over the course of a year.

Medicare Advantage plans are purposely designed to maximize your out of pocket expense while minimizing the carriers out of pocket.

For those with original Medicare and a supplement plan your out of pocket cost for a pump and approved continuous glucose monitor can be $0 if you have Medigap plan F.

And let’s not forget insulin.

Many Advantage plans run your insulin through the drug plan portion of your coverage.

Unless your Advantage plan does not cover prescription drugs. Then your insulin may still be allocated to Part D. Insulin under Part D can run $300 – $500 monthly depending on the type of insulin and dosage. It also varies by where you are in regard to the donut hole.

 

Medigap and Your Diabetes

Under original Medicare, if you have a pump, with or without a CGM, your insulin is covered by Part B. That means your out of pocket cost could be $0 for the year if you have a Medigap plan.

The BEST time to purchase a Medicare supplement plan is when your Part B goes into effect and you are turning 65 or older.

Georgia Medicare Plans specializes in helping seniors find Medicare supplement plans with the lowest premiums in their area. Our exclusive report shows you every Medigap plan in your area based on your age and gender. No need to waste time searching for the best rates. We shop, you compare. Call or email.

You can also run your own Medigap quotes from the comfort of your home.

CGM Monitors - Georgia Medicare Supplement Rates

You have questions. We have answers. Never any selling.

 

#CGM #ContinuousGlucoseMonitor #DexcomG5#InsulinPump #MedicareDiabetes #MedicareDiabeticCoverage #GeorgiaMedicareSupplementRates

 

Medicare and Diabetes

Does Medicare pay for diabetes treatment? How about diabetic supplies? Will my Medicare plan pay for insulin? How can I save money on my diabetic prescription drugs?

If you have diabetes, you need a good Medicare plan that will cover most of your out of pocket costs for care and allows you the freedom to choose your own doctor. Once you find a doctor that can help you regulate your sugar levels, you don’t need to be forced into changing doctors every few years.

This means finding a good Medicare supplement (Medigap) plan you can keep as long as you live. With over 170 different Medigap plans in Georgia, we can help you find the one that fits your needs and budget.

Instant GA Medigap quotes online. No waiting. We never sell your information.

Georgia Medigap plans & Prices

Georgia Medigap plans & Prices

Shop and compare now.

 

Medicare and Diabetes

If your diabetes has been under control for most of your life, consider yourself fortunate. I have friends that are diabetic, both type I and type II. Some have lived most of their life without major issues. Others have not.diabetic

Consider this. According to the Diabetes Care Project

  • 26 million people in the US have diabetes
  • 79 million have “pre-diabetes”, 7 million have UNDIAGNOSED diabetes
  • More than 90% of diabetics are type II and obesity contributed to most of those cases
  • The US spends $174 million each year to treat diabetics; $119 million in direct health care costs
  • $1 out of every $3 spent by Medicare is to cover the cost of care for diabetes
  • Diabetics have medical expenditures that are more than 2x that of non-diabetics
  • The average annual cost of care for diabetics is $13,700 with $7,900 of that tied directly to the disease
  • The costs of treating diabetes rose 41% from 2007 to 2012

The longer you have diabetes, the greater chance you have of incurring high medical costs and complications. This is not the time to manage your illness and out of pocket costs with a Medicare Advantage plan.

 

Medicare Coverage forDiabetes Treatment

Original Medicare Part B covers the cost of testing equipment and supplies, insulin pumps and therapeutic shoes.

Part B also covers regular screening, diabetes self management training, nutrition therapy services, A 1c and glaucoma testing and much more. Check out Publication 11022 for more details.

medicare diabetesOral medication and self injecting insulin (not for a pump) are covered by Medicare Part D.

Don’t get sucked into the deals that promise free diabetic supplies. If you get an unsolicited call offering FREE diabetic supplies, hang up. Diabetes Health has this to say.

Scammers often pose as federal employees or workers representing legitimate diabetes associations. They’re looking for Medicare and Social Security numbers, as well as other financial information, that they can use fraudulently on their own behalf or sell to criminal syndicates.

Fraudsters that actually do send diabetes supplies send supplies that are inferior in quality, and then turn around and fraudulently bill Medicare for the order. “Free” supplies offered include glucose meters, diabetic test strips, and lancets, as well as such items as heating pads, lift seats, foot aids, or braces.

If you get such a call, immediately hang up and call the fraud hotline (1-800-HHS- TIPS, 1-800-447-8477)

 

Medicare and Prescription Drugs

The weakest link in the Medicare program is Part D, the prescription drug plan. Nowhere is it more obvious than when it comes to covering the cost of diabetic drugs.

Insulin can be very expensive, especially if you use a pen instead of a needle. The NovoLog patient assistance program can be a financial lifesaver for those who qualify.

Other PAP’s (Patient Assistance Programs) are another option.

We will review PAP’s in more detail in a future post.

 

Don’t Pay Too Much for Your Medicare Supplement Plan

Almost every day we talk to people who have bought the wrong Medicare plan for their needs, are paying too much, or both.

We recently compared plans for a lady who lived in zip code 31630, was turning 65 and going on Medicare. After talking with her friends she had decided to buy plan F from either Blue Cross or United Healthcare (through AARP). She was told that plan F  “pays everything” (which is true) and that she should go with a big carrier that will pay all her claims.woman shaking fist

Of course no one told her that ALL the carriers pay 100% of the contractual claims approved by Medicare. The normal claim process is your doctor files with Medicare, Medicare approves the claim, your supplement plan pays their portion.

A routine claim will take a couple of weeks with Medicare and about another week with the Medigap carrier.

Any doctor that participates in Medicare will also accept ANY Medigap plan, regardless of the issuing carrier.

Blue was going to charge this woman $168 per month. She could save a few dollars with the AARP/UHC plan F for $166.

But she can save even more by using a carrier I represent that will pay her claims in the same manner as Blue and UHC but with a monthly premium of $126 per month. That $40 per month savings adds up quickly!

Maybe she should consider new friends.

Better yet, introduce me to her friends so they can save money too.

Medicare shop and compare

Diabetes can be expensive. Let us show you a number of ways to minimize your out of pocket costs.

 

#MedicareDiabetes #Insulin  #DiabeticSupplies  #MedicareSupplement #MedicareAdvantage