How To Get a Continuous Glucose Monitor (with Private Insurance, Medicare or Medicaid)

Who’s eligible for a Steady Glucose Monitor (CGM) and how one can get one has modified loads within the final 12 months.

If you happen to’ve been denied a CGM previously, or in the event you’re simply in search of a smoother, much less time-consuming approach to get your diabetes provides, now’s the time to take motion.

Let me stroll you thru the totally different choices and the way I get my CGM (and different diabetes provides).

This submit is sponsored by US MED.

Who’s eligible for a CGM and what has modified not too long ago?

I’ve been dwelling with sort 1 diabetes since 1997 and began utilizing the Dexcom Steady Glucose Monitor about 6 years in the past, and I feel it has been some of the highly effective enhancements to my diabetes administration.

The CGM permits me to see my blood sugar readings 24/7 on my telephone or a receiver and alerts me if my blood sugars begin to go too excessive or low so I may be proactive in my care.

However not everybody dwelling with diabetes within the US has entry to CGM, actually because their (personal or authorities) insurance coverage gained’t cowl it. However the excellent news is that loads has occurred and it has now grow to be simpler to be accredited for a CGM.

CGM protection when you have personal insurance coverage

Most personal insurance policy cowl CGM for folks dwelling with diabetes, however you’ll should verify your insurance coverage advantages to see if that’s the case along with your plan, which manufacturers it covers, and at what value.

Plan protection can change from 12 months to 12 months, so when you have been denied protection previously, it’s value checking up in your plan profit yearly or selecting a plan that covers CGM throughout open enrollment (which is normally November by means of January).

Most individuals can have some kind of copayment when utilizing a non-public insurance coverage plan. If you happen to, for instance, have a 20% co-pay, that signifies that you’ll pay 20% of the worth your insurance coverage plan has negotiated with the CGM producer.

If you happen to use a distributor to your medical provides, equivalent to US MED  that I’m utilizing, they are going to contact your insurance coverage firm for you, earlier than you even join with them, to seek out out in the event you’re coated and what your co-pay is.

CGM protection when you have Medicare

Over 62 million persons are enrolled in Medicare within the US and about 30% of these folks stay with diabetes.

There are a number of standards an individual has to satisfy to be eligible for a CGM by means of Medicare, however a redundant barrier to protection was eliminated not too long ago which ought to make it simpler to get protection for CGM.

This barrier was eliminated in the beginning of July 18, 2021, the place Medicare eradicated the four-time-daily fingerstick testing requirement for CGM protection.

So when you have been denied protection previously since you didn’t manually verify your blood sugar 4 occasions each day, now’s the time to re-apply for CGM protection.

To be eligible for protection by means of Medicare, you continue to have to satisfy these standards:

• You will need to stay with diabetes
• It’s important to handle your diabetes with a number of (three or extra) each day insulin injections (MDI) or an insulin pump
• You will need to require frequent insulin self-adjustment primarily based on the CGM or finger sticks
• You will need to have seen a medical skilled in particular person inside 6 months previous to ordering the CGM
• You will need to see the prescribing medical skilled in particular person each 6 months following the preliminary prescription of the CGM

Your out-of-pocket value to your CGM will depend upon what your Medicare profit plan seems to be like. However as an alternative of spending hours on the telephone making an attempt to get by means of to a Medicare consultant, an alternative choice is to only attain out to US MED and have them run the numbers for you.

It’s tremendous straightforward, simply go to USMED.com and you’ll contact them electronically or give them a name.

CGM protection when you have Medicaid

Though it’s nice that almost all personal insurance policy and Medicare now covers CGM for extra folks dwelling with insulin-dependent diabetes, sadly, Medicaid protection is a little more sporadic. 

Medicaid is the only largest supply of well being protection in the US, offering medical health insurance to greater than 80 million People. 

Medicaid overage differs tremendously from state to state which makes it tougher to determine in the event you’re coated, and sadly many states don’t cowl CGMs of their Medicaid packages. 

Anybody dwelling with diabetes underneath the age of 21 on any Medicaid program qualifies for a CGM, however for anybody older than 21, it turns into a bit extra sophisticated.

20 states (21 in 2022) presently have pretty complete Medicaid protection of CGM for folks dwelling with any sort of diabetes, whereas 22 states solely have protection for folks dwelling with sort 1 diabetes and seven states don’t have any printed protection.

Who qualifies additionally differs from state to state with most states requiring prior authorization from a physician, however you’ll should verify along with your state’s Medicaid program for particular eligibility standards, or attain out to a distributor equivalent to US MED.

If you happen to resolve to get a CGM, whether or not it’s by means of your insurance coverage otherwise you resolve to go forward and pay for it your self, you could have totally different choices in relation to supply.

Neither of essentially the most often used CGM manufacturers, being Dexcom or Freestyle Libre, promote on to the person. You used to have the ability to get your CGM immediately from Dexcom right here within the US, however they discontinued that utterly in Could 2021.

That signifies that you need to use a distributor or get your CGM out of your native pharmacy (in the event that they carry it). I normally get my diabetes provides and insulin from my native pharmacy however they don’t carry Dexcom so I get my CGM from US MED, which is a distributor.

US MED is an accredited nationwide distributor of CGMs, diabetes testing provides, insulin pumps, and extra. With the change in insurance coverage {qualifications} standards, they settle for 100s of personal insurance coverage suppliers and Medicare. Additionally they get nice evaluations on Google and Fb!

What I like about US MED is that it’s really easy to make use of and really handy. You merely go to the US MED web site and both fill out the net kind or name them for a free advantages verify. You might be then assigned a private customer support rep, a characteristic I don’t know of some other diabetes provides firms which have, and that rep takes care of you from there.

When you resolve to get your provides (which for me is my Dexcom CGM, however once more, additionally they ship FreeStyle Libre CGM, check strips, and different medical gadgets), they’ll present free delivery of your 90-day provide on to your private home with UPS.

When it’s time to reorder, you are able to do it simply over textual content message, the net portal, or over the telephone. It solely takes seconds!

They’ll even offer you computerized reorder reminders like textual content, e mail, or calls so at all times keep in mind to reorder your diabetes provides.

Tremendous straightforward, and you’ll at all times check out your account by logging into the affected person portal. The portal is useful as a result of it retains all your information in a single place. You monitor delivery and see all your earlier orders in a safe on-line setting.

It additionally saves you time from having to name in in case your private information has modified, like deal with, insurance coverage protection, or doctor’s identify.

So in the event you’re contemplating a CGM or are in search of a fantastic resolution to have your 90-day provides delivered on to your door, I counsel you give US MED a name to study in the event you qualify for a CGM, what your out-of-pocket prices shall be, and to arrange your subsequent supply.