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.
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.
Table of Contents
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.
You have questions. We have answers. Never any selling.
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