Who’s eligible for a Steady Glucose Monitor (CGM) and how one can get one has modified loads within the final yr.
In case you’ve been denied a CGM previously, or should you’re simply searching for a smoother, much less time-consuming method to get your diabetes provides, now’s the time to take motion.
Let me stroll you thru the completely different choices and the way I get my CGM (and different diabetes provides).
This put up 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 believe it has been one of the crucial highly effective enhancements to my diabetes administration.
The CGM permits me to see my blood sugar readings 24/7 on my cellphone or a receiver and alerts me if my blood sugars begin to go too excessive or low so I might 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 received’t cowl it. However the excellent news is that loads has occurred and it has now change into simpler to be accepted for a CGM.
CGM protection in case you have personal insurance coverage
Most personal insurance policy cowl CGM for individuals dwelling with diabetes, however you’ll need to verify your insurance coverage advantages to see if that’s the case together with your plan, which manufacturers it covers, and at what worth.
Plan protection can change from yr to yr, so in case 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 often November by means of January).
Most individuals can have some type of copayment when utilizing a non-public insurance coverage plan. In case you, for instance, have a 20% co-pay, that implies that you’ll pay 20% of the value your insurance coverage plan has negotiated with the CGM producer.
In case you use a distributor to your medical provides, corresponding to US MED that I’m utilizing, they are going to contact your insurance coverage firm for you, earlier than you even enroll with them, to search out out should you’re lined and what your co-pay is.
CGM protection in case you have Medicare
Over 62 million persons are enrolled in Medicare within the US and about 30% of these individuals dwell 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 originally of July 18, 2021, the place Medicare eradicated the four-time-daily fingerstick testing requirement for CGM protection.
So in case you have been denied protection previously since you didn’t manually verify your blood sugar 4 instances every 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 should dwell with diabetes
- You need to handle your diabetes with a number of (three or extra) every day insulin injections (MDI) or an insulin pump
- You should require frequent insulin self-adjustment based mostly on the CGM or finger sticks
- You should have seen a medical skilled in particular person inside 6 months previous to ordering the CGM
- You should 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 appears to be like like. However as an alternative of spending hours on the cellphone attempting to get by means of to a Medicare consultant, an alternative choice is to simply 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 in case you have Medicaid
Though it’s nice that the majority personal insurance policy and Medicare now covers CGM for extra individuals dwelling with insulin-dependent diabetes, sadly, Medicaid protection is a little more sporadic.
Medicaid is the only largest supply of well being protection in america, offering medical insurance to greater than 80 million People.
Medicaid overage differs tremendously from state to state which makes it tougher to determine should you’re lined, and sadly many states don’t cowl CGMs of their Medicaid packages.
Anybody dwelling with diabetes beneath 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) at present have pretty complete Medicaid protection of CGM for individuals dwelling with any sort of diabetes, whereas 22 states solely have protection for individuals 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 health care provider, however you’ll need to verify together with your state’s Medicaid program for particular eligibility standards, or attain out to a distributor corresponding to US MED.
Dexcom doesn’t ship on to prospects anymore, now what?
In case you 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 have got completely different choices relating to supply.
Neither of probably the most continuously used CGM manufacturers, being Dexcom or Freestyle Libre, promote on to the person. You used to have the ability to get your CGM instantly from Dexcom right here within the US, however they discontinued that fully in Might 2021.
That implies that it’s a must to use a distributor or get your CGM out of your native pharmacy (in the event that they carry it). I often 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. In addition 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 web kind or name them for a free advantages verify. You’re then assigned a private customer support rep, a characteristic I don’t know of another 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 house with UPS.
When it’s time to reorder, you are able to do it simply over textual content message, the web portal, or over the cellphone. It solely takes seconds!
They’ll even provide you with computerized reorder reminders like textual content, electronic mail, or calls so all the time bear in mind to reorder your diabetes provides.
Tremendous straightforward, and you’ll all the time 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 atmosphere.
It additionally saves you time from having to name in in case your private data has modified, like handle, insurance coverage protection, or doctor’s title.
So should you’re contemplating a CGM or are searching for an incredible resolution to have your 90-day provides delivered on to your door, I counsel you give US MED a name to study should you qualify for a CGM, what your out-of-pocket prices shall be, and to arrange your subsequent supply.
