I am going on Medicare in July, wondering the best Medicare plan to subscribe to? I am on a cgm and insulin pump.
I live in NJ
you might want to check out these groups
http://www.tudiabetes.org/group/pumpingseniors
http://www.tudiabetes.org/group/seniorswithdiabetes
http://www.tudiabetes.org/group/cgm-advocacy
good luck, I'd be interested in what you find out.
Joan, generally medicare does not cover the CGM at all. That means that almost no supplements cover it either. I do not knwo of any in any state that do. In terms of the pump medical cares the pump and to my knowledge unless the supplemental insurance specifically says they will not cover it, then it is a covered item. Now I woudl check that since I am not on a traditional supplement and will not be for a while.
in terms of the CGM, we do have some (3 or 4) members who have appealed the denial of CGM coverage up the medicare chain and have been successful in getting coverage. Many of us here have written our congressional representatives asking that they support legislation to expand coverage to include CGM's. Obviously this has not happened as yet and it will likely not happen in the near future, despite our ardent wish that something be done.
Those who have won via appeal have found that they must appeal as many as 5 times to gain a favorable decision and this may take up to a year to be successful. I do not knwo how many may have appealed this amount of time and lost their case.
For the most part i cannot advise on specific NJ supplemental plans. i know in Indiana, the supplemental plans all cover pumps and supplies and none cover CGM absent a favorable ruling by medicare on coverage of the CGM.
I wish you the very best, if i can help further please let me know.
Rick
Joan: I know of no Medicare Plan that covers a CGM. I believe that the insulin pump is no problem. That should be covered. Medicare considers the CGM "precautionary" and therefore not covered. Understanding why this is, is beyond explanation. I am the wife of a diabetic and have been fighting the system for over a year now. My husband was on a CGM and when it needed to be replaced, Medicare denied payment. We went through an Administrative Law Judge hearing in June and just got an UNFAVORABLE decision. Our journey is documented in www.testguessandgo.com under Sue from Pennsylvania. You can see our whole story there.
United Healthcare AARP is what I use and my CGM is covered but the pump isn't.
I'm totally confused by this. As far as I know, the pump is covered but not the CGM. My husband is also newly AARP and the handbook says that the CGM is not covered. Could you please explain? Do you have retirement insurance from a former employer. These are the only people I know of who have coverage for the CGM...through their secondary retirement insurance.
I am not adding much but, I concur with those who say that Medicare covers the pump, with verification of need, and does not cover cgm. My endo reached 65 last year and could not find a supplement to cover his cgm!
I am one of the fortunate few who worked for the federal government for 8 years before retiring and kept my BCBS as a supplement. I pay big, big premiums to Medicare and BC each month but my supplement covers my cgm and supplies. And anything else that Medicare doesn't cover. But again, I am one of the lucky few. Or however many fed workers there are who had the good insurance before retiring. Not sure all fed supplements cover cgm either.
I do think that activist individuals and groups with diabetes, in the U.S., should band together and get a change in Medicare re cgm.
An aside, it is best to read the coverage in an actual policy rather than calling. I have gotten different answers on different days with different people, with Medicare in particular. I assume it holds true for any health insurance company.
PS again. Here in NC, a number of my friends like the AARP supplement. But then they are not on a handful of meds like me so I don't know how it would work for more chronic illnesses, and med needs, in a person.
Think I posted this on another discussion but here is the link for the H.R. bill 3710 which is asking that Medicare cover CGM's. Contact your Congress person and ask that they support this and show how it will save lives and money in the long run.
http://beta.congress.gov/bill/113th-congress/house-bill/3710
Please read my blog on testguessandgo.com entitled “Join a The Crusade”. It will give you the links to your Congressperson and also a sample letter you can use to write that person. Extremely important that we all start banding together. Also join the TuDiabetes a CGM advocacy group so that we can toss ideas around.
thank you for your reply. I have had diabetes for 53 years and just started on CGM. I found I was not feeling lows like I used to. I start feeling anxious and found my blood sugar is going low. Would not have known that except for CGM. I will just use the sensors intermittently as long as they last until Medicare understands it saves everyone money if diabetics do not have to be hospitalized if they are in good control.
Thank you, I think I will do once a month until supplies last. I am hoping I can place an order before I go on Medicare.
Contacted my representatives and hope everyone else does. Just saw that medicare spent $172 million dollars on penis pumps but wont' cover our CGM's or my Omnipod pump! Disgraceful.
Here's the link.
http://testguessandgo.com/2014/02/17/join-the-crusade/
Thank you for putting in the link to my blog. Hope everyone takes your advice and contacts their Congressperson.
Don't you think that the CGM manufacturers are doing everything they can to put pressure on Medicare to pay for their product?
Dexcom says that they and Medtronic are going to be doing a big push towards legislation but so far, I haven't heard anything concrete about it and it's not coming fast enough for those on a CGM who need it now. This has been an issue for quite a long time. We've been fighting for it for over a year but I have documentation from others who have been fighting it longer. I wish I knew the answer. We do have to band together to fight for H.R. 3710 so that we're cohesive. Please join the Tudiabetes CGM Reimbursement Group, write your Congressperson using the links on testguessandgo.com, tell your friends about H.R. 3710 and get the word out by any means you can think of.
Talk with your physician and find what best works for you. Labs is what the CGM and pump are based on. If your A1C is with in "normal" limits what your doctor writes down on the order of very high importance. I no longer have symptoms or signs when my BGl goes low therefore a CGM was not only helpful but was needed to keep me alive. Unfortunately my A1C is 5.6 and a pump is not considered a life or death measure. My CGM is covered and I don't have a pump.
If you are on Medicare, it doesn't matter what your A1C. CGM is not covered. Your doctor can fill out a form of Medical Necessity and Medicare still won't cover the CGM. They consider it "precautionary" and not a necessity. It doesn't matter if you have hypoglycemia or hyperglycemia unawareness. It still isn't covered by Medicare. You can show labs, graphs charting your lows and highs...it still doesn't matter. You can show proof of episodes where you've had to be revived by EMS...it still doesn't matter. The guideline has to be changed. Please read my blogs on www.guesstestandgo.com and you will see what we have gone through trying to get coverage for a CGM for my husband.
Joan: Are you type 1 or 2? If you are type 1 and your c-peptide is less than 110% of the lab lower limit, you will have no problem with Medicare. Type 2's have a problem when it comes pump replacement time. Any diabetic already on an insulin pump when they start Medicare are covered for all pump supplies, Insulin, and testing supplies under part B. Check with your pharmacy to see if they can bill part B, not all can. Walgreens is one national chain that files part B. As others have stated, CGM's are not covered by medicare. All Medicare plans are required to cover at least as much as basic Medicare. If you have any other chronic conditions and/or medications, that is what you will have to research.
Steve