It looks like my insurance approved my Dexcom. I got the email that it is shipping today. Some of you might remember I was on the fence about getting one. I decided to take the dive. I really didn’t expect it to be approved, given I am on the Horizon NJ Health plan, which is NJ’s Medicare through the Obamacare system. They asked for the certificate of medical need, a prescription from my doctor, and I had to send them 3 months worth of blood sugars. Has anyone else with Medicare been successful in getting one approved on Medicare? I was under the impression it was very difficult, if not impossible. I didn’t even have to file any appeal.
I’m over 65 but not yet on Medicare so I don’t understand all of the insurance angles, but I was under the impression that Medicare absolutely doesn’t give coverage for CGM yet, and if Medicare doesn’t, than the plans that are supplemental (or whatever they are called) also won’t cover it. I even read about Medicare not covering CGM on their own site a few days ago, so what gives?
I was also under the impression they just wouldn’t cover it. I called and asked my plan provider and they told me they cover them with the above mentioned requirements and after a medical review. I figured that was just them saying they did to avoid flat out saying no, and that after sending them the requested information, they would deny it. To my surprise, without hearing a word from insurance, when i checked my email this morning, I had a shipment notification from Dexcom. I’m under 65, but on this insurance plan for now due to disability.
Thank you for that info! Judging from all the positive comments, it seems almost a done deal that you will love the Dexcom. Please post your experience with it, if you wouldn’t mind.
Technically, it’s NJ’s Medicaid, not Medicare, so the rules are different.
Regardless, congratulations! The Dex has made a real difference in my ability to increase my TIR (aka - Time In Range). I have many more days where I live “between the lines” for big chunks of time.
It took me a while to really pay attention to what the Dex is telling me, and I still have my excursions but, I love it!
Congrats on starting your CGM. I’ve found it to be one of the most effective changes I’ve made to keep my BGs in range. One trick that I’ve learned recently is dose my meal insulin and wait for the CGM line to bend downward before I start eating. I’ve been doing this for breakfast, a time of day when I am insulin resistant. I find it takes 60-75 minutes before the line trends downward. When I do this, my post-breakfast line often stays under 120 mg/dl.
I do have to be careful that my food is handy and that I can eat when that bend happens. You’d have to be careful that you don’t get side-tracked with a phone call or some other unplanned interruption or you could go hypo. Managing the social side of diabetes is sometimes the more difficult piece!
Congrats on the CGM. I am on a Medicare advantage plan through United Health Care and have had no problems (so far) getting coverage on my Dexcom and supplies. I’ve been using it for a little over two years now. Best thing I ever did for diabetes, even better than the pump. Good luck with yours.
@phoenixbound - Oh, the tangled web of insurance … [quote=“KCsHubby_Dave, post:9, topic:46549”]
I am on a Medicare advantage plan through United Health Care
[/quote] (bolding is mine)
Medicare Advantage plans offered by some insurers like United HealthCare may offer coverage for CGMs. This doesn’t change what Medicare covers however.
RIght. but I was under the impression (I HOPE, falsely) that the entire spectrum of Medicare-type coverage excluded CGM. When I go on Medicare, I’ll be getting some additional coverage with that, but had thought that there was no way to get any sort of plan along with Medicare, that had coverage for CGM. This matters to me, as at some point in the next few month or so, I may need to move away from private insurance to the Medicare nightmare.
phoenixbound - I just started on Medicare last year. I earned both pre- and post-Medicare supplemental insurance coverage through my job. That job coverage included durable medical equipment coverage with my post-Medicare Aetna policy.
Most policies that coordinate with Medicare use a simple coverage clause; if Medicare covers it they will. too, if Medicare doesn’t cover it they will not. My Aetna policy, however, does not work like that. My Aetna Medicare supplemental policy covers durable medical equipment regardless of Medicare eligibility. It’s the typical 80/20 split where I pay 20% up until my annual major medical threshold of $1500 out of pocket is hit. Then Aetna will pay 100% of all my claims (after Medicare) including durable medical equipment.
I think the insurance coverage in the US is needlessly complicated. I was surprised to learn that some Medicare Advantage plans cover CGMs.
AWESOME! I currently have Aetna PPO and I must say it is one of the best policies I have had out of approximately 9 or more different companies. I hope that Aetna has a plan that is for someone ONLY on Medicare, rather than it being a group plan type of policy through ones workplace.
