Who’s eligible for a Steady Glucose Monitor (CGM) and how one can get one has modified so much within the final yr.
For those who’ve been denied a CGM up to now, or should you’re simply searching for a smoother, much less time-consuming solution 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 publish is sponsored by US MED.
Who’s eligible for a CGM and what has modified lately?
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 probably the most 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 will 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 so much has occurred and it has now turn out to be simpler to be accredited for a CGM.
CGM protection in case you have personal insurance coverage
Most personal insurance coverage cowl CGM for folks dwelling with diabetes, however you’ll need to examine 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 up to now, 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 may have some form of copayment when utilizing a non-public insurance coverage plan. For those who, 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.
For those who use a distributor on your medical provides, corresponding to US MED that I’m utilizing, they may contact your insurance coverage firm for you, earlier than you even join with them, to seek out out should you’re coated 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 folks reside 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 lately which ought to make it simpler to get protection for CGM.
This barrier was eliminated at first 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 up to now since you didn’t manually examine your blood sugar 4 instances day by 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 could reside with diabetes
- You must handle your diabetes with a number of (three or extra) day by day insulin injections (MDI) or an insulin pump
- You could require frequent insulin self-adjustment based mostly on the CGM or finger sticks
- You could have seen a medical skilled in particular person inside 6 months previous to ordering the CGM
- You could see the prescribing medical skilled in particular person each 6 months following the preliminary prescription of the CGM
Your out-of-pocket value on your CGM will rely upon what your Medicare profit plan appears to be like like. However as an alternative of spending hours on the telephone 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 simple, simply go to USMED.com and you may contact them electronically or give them a name.
CGM protection in case you have Medicaid
Though it’s nice that almost all personal insurance coverage and Medicare now covers CGM for extra folks dwelling with insulin-dependent diabetes, sadly, Medicaid protection is a little more sporadic.
Medicaid is the one largest supply of well being protection in the US, offering medical health insurance to greater than 80 million People.
Medicaid overage differs enormously from state to state which makes it more durable to determine should you’re coated, and sadly many states don’t cowl CGMs of their Medicaid applications.
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 difficult.
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 haven’t any printed protection.
Who qualifies additionally differs from state to state with most states requiring prior authorization from a physician, however you’ll need to examine 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?
For those who determine to get a CGM, whether or not it’s by means of your insurance coverage otherwise you determine to go forward and pay for it your self, you will have completely different choices in terms of 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 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 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. In addition they get nice critiques 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 type or name them for a free advantages examine. You’re then assigned a private customer support rep, a characteristic I don’t know of some other diabetes provides corporations which have, and that rep takes care of you from there.
When you determine to get your provides (which for me is my Dexcom CGM, however once more, additionally they ship FreeStyle Libre CGM, take a look at strips, and different medical units), 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 bear in mind to reorder your diabetes provides.
Tremendous simple, and you may at all times inspect your account by logging into the affected person portal. The portal is useful as a result of it retains your entire data in a single place. You observe delivery and see your entire earlier orders in a safe on-line atmosphere.
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 title.
So should you’re contemplating a CGM or are searching for an important 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 will probably be, and to arrange your subsequent supply.
