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.

 

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Medicare Part B – What Does Part B Cover?

Medicare Part B. What does it cover? Do you need Medicare Part B? If you don’t buy Medicare Part B what is my exposure? Can you buy a Medigap plan if you don’t have Part B? Are you turning 65Medicare Part B - Turning 65

Medicare Part B is thought of as covering doctor visits. Truth is, Part B covers much more than just a visit to the doctor.

Part B covers outpatient doctor services including office visits.

 

Medicare Part B Durable Medical Equipment

Most durable medical equipment (DME) is covered under Medicare Part B.  Medically necessary medical equipment can be purchased or rented  from an approved Medicare DME provider.

Not all DME is covered by Medicare {art B. Before Medicare will pay for your durable medical equipment it must meet the following criteria.

  • The equipment cannot be designed solely for single use
  • Your DME must be medically necessary and serve a specific medical purpose
  • The equipment should be designed to last 3 or more years
  • They equipment must be distributed by an approved Medicare DME supplier

Examples of DME covered by Medicare include oxygen equipment, wheelchairs, walkers, hospital beds and scooters . . . but not hearing aids.

Most preventive services, including those available at no charge to you, are covered under your Part B benefits.

Outpatient services, such as speech or physical therapy are included in your Part B benefits.

Some services by medical transport companies (ambulance) are included in Part B.

Medically necessary spinal manipulation as performed by a chiropractor is a Part B covered item.

Some outpatient psychiatric care, including group and individual counseling or therapy is covered by Medicare Part B.

X-rays, CT scans, MRI, PET and lab tests are included in your  Part B benefit package.

Home health services and medically necessary services provided by a skilled nursing facility (SNF) are part of your Medicare Part B coverage.

Most drugs are paid by your Medicare Part D, but drugs administered in a clinical setting, such as chemotherapy, are included in Medicare Part B.

 

Other Part B Covered Expenses

Sleep apnea may require the use of a CPAP machine. But not all machines are eligible and some DME providers are not approved by Medicare.

Diabetic insulin is normally a Part D covered item. But if you have a pump your insulin may be a Medicare Part B covered item.

 

Lower Out of Pocket Costs

Most people fear huge hospital bills. When you have original Medicare your OOP (out of pocket) for most hospital charges is limited to your deductible.

Huge medical bills running $20,000 and more are usually incurred as outpatient Part B expenses. Unlike health insurance you had in the past there is no OOP limit. Medicare pays 80% of approved charges after your calendar year deductible. You are responsible for the remaining 20%.

There is no cap.

You continue paying until you get well, run out of money or die.

Medicare supplement plans F and G limit your Part B exposure to less than $200 in 2017. For a few dollars a day in Medigap premiums you can have peace of mind.Turning 65 GA Medicare supplement plans

There are more than 170 different approved Medicare supplement plans in Georgia. Which one is right for you?

Give us a call. We are glad to help.

Georgia Medicare Plans has affordable Medigap rates for seniors on Medicare Part A and Part B.

 

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