Who’s eligible for a Steady Glucose Monitor (CGM) and how one can get one has modified loads within the final yr.
In the event you’ve been denied a CGM previously, or for those who’re simply searching for a smoother, much less time-consuming technique 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 (non-public or authorities) insurance coverage gained’t cowl it. However the excellent news is that loads has occurred and it has now turn into simpler to be accredited for a CGM.
CGM protection you probably have non-public insurance coverage
Most non-public 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 along with your plan, which manufacturers it covers, and at what worth.
Plan protection can change from yr to yr, so you probably have been denied protection previously, it’s price checking up in your plan profit yearly or selecting a plan that covers CGM throughout open enrollment (which is often November by January).
Most individuals may have some form of copayment when utilizing a personal insurance coverage plan. In the event 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 the event you use a distributor in your medical provides, equivalent to US MED that I’m utilizing, they may contact your insurance coverage firm for you, earlier than you even enroll with them, to seek out out for those who’re lined and what your co-pay is.
CGM protection you probably have Medicare
Over 62 million individuals 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 meet to be eligible for a CGM by 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 in the beginning of July 18, 2021, the place Medicare eradicated the four-time-daily fingerstick testing requirement for CGM protection.
So you probably have been denied protection previously since you didn’t manually verify your blood sugar 4 occasions every day, now’s the time to re-apply for CGM protection.
To be eligible for protection by Medicare, you continue to have to meet these standards:
- You will need to 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 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 individual inside 6 months previous to ordering the CGM
- You will need to see the prescribing medical skilled in individual each 6 months following the preliminary prescription of the CGM
Your out-of-pocket price in your CGM will rely on what your Medicare profit plan appears like. However as a substitute of spending hours on the telephone making an attempt to get by to a Medicare consultant, another choice is to only attain out to US MED and have them run the numbers for you.
It’s tremendous simple, simply go to USMED.com and you’ll contact them electronically or give them a name.
CGM protection you probably have Medicaid
Though it’s nice that almost all non-public 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 the US, offering medical health insurance to greater than 80 million Individuals.
Medicaid overage differs enormously from state to state which makes it tougher to determine for those who’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) presently 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 revealed protection.
Who qualifies additionally differs from state to state with most states requiring prior authorization from a physician, however you’ll need to verify along with your state’s Medicaid program for particular eligibility standards, or attain out to a distributor equivalent to US MED.
In the event you resolve to get a CGM, whether or not it’s by your insurance coverage otherwise you resolve to go forward and pay for it your self, you’ve got completely different choices in the case of supply.
Neither of essentially the most often used CGM manufacturers, being Dexcom or Freestyle Libre, promote on to the consumer. You used to have the ability to get your CGM instantly from Dexcom right here within the US, however they discontinued that utterly in Might 2021.
That implies that you must 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 net type or name them for a free advantages verify. You’re then assigned a private customer support rep, a function 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, in addition they ship FreeStyle Libre CGM, check 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 provide you with automated reorder reminders like textual content, electronic mail, or calls so at all times bear in mind to reorder your diabetes provides.
Tremendous simple, and you’ll at all times investigate cross-check 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 information has modified, like handle, insurance coverage protection, or doctor’s identify.
So for those who’re contemplating a CGM or are searching for a fantastic resolution to have your 90-day provides delivered on to your door, I counsel you give US MED a name to be taught for those who qualify for a CGM, what your out-of-pocket prices shall be, and to arrange your subsequent supply.
