I will be going on Medicare this year and am wondering if anyone can tell me if Medicare pays for the CGM does the supplemental cover testing supplies or, do you have to pay out of pocket?
For me, and I think for T1D on medicare, they pay for test strips and supplemental pays the extra 20%. Need to get a doctor to prescribe the amount of test strips you use.
Thanks. I am wondering about the payment for the CGM. Some where I read that medicare will pay for it but not testing supplies.
I am on original Medicare with a Medicare supplement plan. I have the Dexcom g5. I receive my supplies directly from Decxom.
Every month I answer a short email based quiz on how many sensors, test strips and lancets I have on hand. If I answer ‘zero’ boxes of test strips, they will send me three 50-count boxes for the upcoming month.
All this is paid through Part B (80%) and my supplement (20%).
I am also on original Medicare with a supplement. I am happy to say that, between Medicare and the supplement, all of my CGM supplies and test strips are covered with no out-of-pocket costs. I have a Dexcom G5 and use the “bundled” Contour meter for calibration.
That said, not everyone on Medicare is covered: there are some requirements to be covered. As I understand it, the key one is that your doctor has to prescribe that you need therapeutic, rather than merely adjunctive, continuous glucose monitoring.
Here are some posts on tudiabetes I have bookmarked regarding Medicare. Lots of good information to be found.
Thanks for the info. So, you get your strips from Dexcom also?
Wow! I had no idea it was going to be so complicated with Medicare. Managing T1 for over 50 years has been a piece of cake compared to figuring out Medicare.
Thanks for the info as to what my doctor should request.
Thanks. I will start looking at the posts.
A couple of followup comments.
Yes, Dexcom sent me a new Bayer Contour meter and I now get strips from them for twice-daily G5 calibration. I had always used One Touch but like the Contour meter’s accuracy.
Also, after checking supplies on hand, Dexcom sends out a monthly shipment of sensors, strips, lancets, and the occasional transmitter.
I was surprised that they aren’t allowed to send 90 days worth of supplies … I suspect that Dexcom was surprised by that ruling from Medicare too.
But, yes, managing insurance is often trickier than managing a chronic disease … universal coverage anyone?
Mary47 - Yes, Dexcom sends me the the Contour test strips along with my sensors.
Thanks John. I am concerned with the amount of strips Dexcom sends you. I not only do my calibration but, also test 4 times more a day. I have found that my readings can sometimes be over 50 points off. There is no way I am going to dose with that difference. Did you send an RX from your Doctor for the strips?
Medicare pays for strips for the quantity that your doctor writes an Rx for. For example, I’ve been getting no less than 400 strips per month for the last couple years, all covered. Now that I’m on a G5, I don’t need as many, but I still get more than the “standard issue” of 150 strips per month. AND, my strips MUST come directly from Dexcom–no longer can I get the additional strips (above the 150 from Dexcom) from a local pharmacy. That has been cut off by Medicare two months ago. Makes no difference to me WHERE they come from, as long as I get them. AAMOF, I JUST got a monthly shipment today from Dexcom and in it, are 6 boxes of strips (that’s 300 total, which is fine as I use less than I used to).
Thanks Dave. Yesterday I spoke with my Dexcom rep and he told me exactly what you said. Just have your doctor write an RX for the amount I need.
I’m on a Medicare Advantage Plan which covers my Medtronic pump and supplies 80%. Part D covers my Contour Next strips (150/month) 100% from Walgreens; however, my doc has to complete a special needs form every year.
I get no Coverage for my CGMS.
You aren’t interested in getting a Dexcom covered by Medicare? Heck, I don’t care much about pump integration: I want a good CGM and Medicare coverage.
Though regular Medicare covers the Dexcom CGMS, Medicare Advantage Plans do not cover any CGMSs.
ah, mine is a supplemental plan thru AARP. Plan F. thru UnitedHealthcare. It’s been fantastic. No OOP.
I do not know where you are but, I am in So. CA and am going with Scan as my supplemental and they cover Dexcom. Dexcom is the only CGM Medicare covers.
My 2017 insurance included the the United Healthcare supplemental which covered my. Medtronic CGMS; however. When my insurance switched to United Healthcare Group Medicare Advantage. I lost coverage. Apparently, Medicare Advantage Plans operate differently than supplemental plans. Unfortunately, I am the looser in this set-up. However, I make up for it by getting no cost test strips.