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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 on the lookout for a smoother, much less time-consuming option to get your diabetes provides, now could be 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 put up is sponsored by US MED.
Who’s eligible for a CGM and what has modified lately?
I’ve been dwelling with kind 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 cellphone 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 (non-public or authorities) insurance coverage gained’t cowl it. However the excellent news is that loads has occurred and it has now turn out to be simpler to be permitted for a CGM.
CGM protection when you have non-public insurance coverage
Most non-public insurance coverage cowl CGM for folks dwelling with diabetes, however you’ll must test your insurance coverage advantages to see if that’s the case together 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 price checking up in your plan profit yearly or selecting a plan that covers CGM throughout open enrollment (which is normally November by January).
Most individuals can have some type of copayment when utilizing a non-public insurance coverage plan. If you happen to, for instance, have a 20% co-pay, that implies 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 in your medical provides, reminiscent of US MED that I’m utilizing, they’ll contact your insurance coverage firm for you, earlier than you even enroll 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 individuals 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 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 when you have been denied protection previously since you didn’t manually test your blood sugar 4 occasions every day, now could be the time to re-apply for CGM protection.
To be eligible for protection by Medicare, you continue to have to satisfy these standards:
- You have to stay with diabetes
- It’s important to handle your diabetes with a number of (three or extra) every day insulin injections (MDI) or an insulin pump
- You have to require frequent insulin self-adjustment based mostly on the CGM or finger sticks
- You have to have seen a medical skilled in individual inside 6 months previous to ordering the CGM
- You have 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 depend upon what your Medicare profit plan appears to be like like. However as a substitute of spending hours on the cellphone attempting to get by 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 simple, simply go to USMED.com and you may contact them electronically or give them a name.
CGM protection when you have Medicaid
Though it’s nice that the majority non-public 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 Individuals.
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 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 sophisticated.
20 states (21 in 2022) at present have pretty complete Medicaid protection of CGM for folks dwelling with any kind of diabetes, whereas 22 states solely have protection for folks dwelling with kind 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 must test together with your state’s Medicaid program for particular eligibility standards, or attain out to a distributor reminiscent of US MED.
If you happen to 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 might have totally different choices relating to supply.
Neither of essentially the most incessantly used CGM manufacturers, being Dexcom or Freestyle Libre, promote on to the consumer. You used to have the ability to get your CGM straight from Dexcom right here within the US, however they discontinued that fully 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 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 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 test. You might be 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 own 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 cellphone. It solely takes seconds!
They’ll even provide you with computerized reorder reminders like textual content, e mail, or calls so all the time keep in mind to reorder your diabetes provides.
Tremendous simple, and you may all the time investigate cross-check your account by logging into the affected person portal. The portal is useful as a result of it retains your entire information in a single place. You monitor delivery and see your entire 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 title.
So in the event you’re contemplating a CGM or are on the lookout for an important answer to have your 90-day provides delivered on to your door, I recommend you give US MED a name to study in the event you qualify for a CGM, what your out-of-pocket prices might be, and to arrange your subsequent supply.
