Does anyone know of any insurance company supplement to Medicare that will pay for cgm and supplies?
I am actually asking for a dr I know who is approaching 65 and going on Medicare. He has a Dex.
Thanks much for info.
we don’t have medicare, but we do have united healthcare, which also does a supplemental with medicare, and we have had no problems getting them to approve, and cover any diabetes related equipment, including my daughters dex and omnipod.
Youll probably not find any medicare suppliment since Medicare still considers it a preventative device and wont cover it, so the supplimental companies dont cover it either…
I have Anthem Blue Cross Blue Shield and I’ll be going on Medicare before I know it. I called Anthem (which will become my secondary insurance then) and they said if Medicare doesn’t cover it, they don’t cover it. Now that’s only my insurance. Yours might be different. There seem to be several on Medicare that are currently disputing the CGM not being covered, but I don’t know of anyone that’s on Medicare getting it covered. Good luck.
Linda
Thanks gxgrandma. I made the mistake of telling my dr that I thought some supplements cover cgm. I am so very lucky because I have the fed Blue Cross as my supplement and they do cover it. So now I think it is only the fed supplements that cover it. We sure need some patient-centered changes in our health care system, not just changes that benefit pharma and insur companies.
Thanks to all who responded.
Hi,
I’ll be going on Medicare in December and have not found any plan willing to cover the CGM and the sensors.
Who is disputing Medicare’s decision? How does one go about fighting Medicare? I would like to get in on this. My Endo feels that the CGM is an absolute necessity for my diabetic control and would be willing to back me.
I’ve written letters to my congressman and to both of my Senators, which to my surprise, have been ignored. I would have thought that they would at least send me some boiler plate response.
Dave
Dave,
Your reps are the first step. Your lack of response verifies that only powerful interest groups are heard by congress. Not sure why the ADA and JDRF are not after congress on this topic, if they are not. I have not checked.
We need a national group that knows how to beat on Congress and are dedicated to this topic. Is there one?
Health care is rapidly dwindling. My best friend is about to be put on a drug for a rare cancer that only responds to one drug, if it responds. It will cost $10,000 q 90 days. Medicare won’t pay because it is oral, not injected, and because it is a drug targeted to this specific cancer cell and not labeled as chemo. So there you are. Where we are today. Our government will find a way not to serve its population when it comes to health care.
What about the Minimed with the INTEGRATED CGM? Is that covered because it's part of the pump?
Linda
I was unable to find an Insurance company who would pay for a CGM until I went on Medicare. All others said it was to experimental. Medicare not only payed for my innitial receiver, but all future replacement sencors. There is no co-pay because they consider it to be hardware, I. E., wheelchairs, etc.
I am now on my second CGM (Dexcom7) and I love it, although there is vast room for improvement. Have not had a serious hypo. incident since obtaining my CGM. No more very high or low glucose because the receiver alerts me at 80mgdl and 200mgdl. My recent A1H was 5.5. This is down two full points from prior to my having a CGM. Experimental my ... .
I'm not sure this makes any difference, but I live in Michigan.
No it does not make a difference 4xgrandma. Medtronic "gives" you the CGMS receiver as it is part of the pump. When you get CGMS along with the pump there are 2 seperate "bills" the insurance pays out on. One for the pump and one for the transmitter. So Medicare will help with the cost of the pump and Medtronic in a way gives you the receiver but in order for you to get the transmitter, not to mention having to continually reorder sensors, there is a CGMS authorization the insurance has to approve to get them to pay.
Jim could you give some info on whether you have Medicare supplements or who/what/how this all works. I have never heard of Medicare covering the cost of sensors except when it is done through a physicians office over a very short period of time (3-7 days). Did you have to fight them? Was there some mitigating factor that they said would allow you coverage?
I would like to know how Jim Devlin got a cgm from Medicare. They told me, earlier this year, that Medicare does not cover it. And that is what I have heard from everywhere else. Are you sure it is not your supplement? I too would like to know your supplement name.
Yes, I have bought parts A&D. I'm not sure if having part D has something to do with my very easy getting all of this. D is for scripts with a $2850 max. per year. This not enough for a T1 diabetic taking 3-4 shots per day. I will check on this and report to you ASAP.
The medicare program is a "can of worms" if there ever was one. There are free asdvisement groups probably everywhere. Take advantage of this for SURE!
I have no factors that were of determinating interest.
Talk at u later Moss.
My supplement is HAP.
Not sure if HAP is available everwhere as it started out many years ago just for Henry Ford Hospital patients here in Michigan.
Now they don't require a client being a HFH patient.
I fought with two Insurace companies for over a year, appeal after appeal. Talked to my congressman. Finally, when old enough, I started with Medicare and they fully accepted the CGM and sencors immediately.
I'd be happy to give you my phone # to discuss these details but I don't think that is allowed here.
Jim
Jim- if I understand right you started HAP after you enrolled in Medicare? That program is not one I have ever heard of so perhaps this is the reason why you get it and others do not.......
My online search indicates that HAP is a Michigan only Medicare plan that grew out of Ford Motor co. I don't know if any neighboring states buy into it.
Sounds like all us diabetics should move to Michigan!
Hi, I made a mistake.
It is HAP which covered me so nicely. This is the Ins. Co. attached to my Medicare.
My wife found this avenue via talking to Great Lakes Medical. They are a medical supplier located here in Michigan.
I can only suggest you first attempt calling GLM in Warren, Michigan to determine if you have an Insurance Co. in your state that covers CGM's, and is included in the Medicare group of available Insur. Co's. A great lady to speak to is Vernita.
If that fails, call your local home med. delivery companies and have them do some research on which Ins. Co's. will cover CGM's and sencors. Remember, under hardware category there is no co-pay.
Nell, see my remarks above.
Medicare always starts first but HAP followed closely behind. You must choose some damn Ins. Co. to have something like decent Ins. and it has to be among Medicare approved companies.
Please see my recent remarks.