Medicare and CGM, test strips

[Mary47]

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?

[rcarli]

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.

[Mary47]

Thanks. I am wondering about the payment for the CGM. Some where I read that medicare will pay for it but not testing supplies.

[anon31175731]

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%).

[John_S2]

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.

Good luck,

John

[Tapestry]

Here are some posts on tudiabetes I have bookmarked regarding Medicare. Lots of good information to be found.

Medicare Guidelines - How to navigate?

Dave, my best social media source for Medicare info as relates to diabetes (primarily Type 1), is a Facebook group called Seniors with Sensors. The group name comes from the years when we were all advocating for CGM coverage by Medicare. The group has morphed into a clubhouse for seniors to discuss various issues related to diabetes coverage, tech issues with CGMs and pumps, how to get insulin under part B, etc.

Medicare Guidelines - How to navigate?

I have T1D and use a DexCom G5 cgm; I do not have a pump. I buy test strips at my local CVS under Medicare. I complete an AOB (Assignment of Benefits) form for CVS annually. Medicare told me I could purchase any brand of test strips I wanted as long as I had a prescription for them. (Lancets are also covered under Part B.) Medicare is extremely strict about refills–it must be 90 days between refills. I’ve been using a DexCom cgm for several years and waited until Medicare approved the G5 …

Medicare

I am planning to enroll in Medicare Plans B, D and F next spring after retirement. There is a quite a bit of financial burden for insulin pen supplies (or Omnipod) under Plan D. UHC’s medical policy # 2018T0347Z, “Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes” has detailed explanation of their policy. Although I have no experience of the DME coverage for Insulin Infusion Pumps and CGMs in Medicare Plan B, I feel this UHC’s medical policy for DME is probably close to…

Medicare Guidelines - How to navigate?

Hi Dave- I have been on Medicare for just over 1 year. I was diagnosed with T1D in 2006. I have used the Medtronic pump and sensor for about 8 years. Medicare covers the pump supplies but not the sensor. I like the “Threshold Suspend” feature of the 530 G pump. Back to Medicare: The rules are absolutely crazy. I cannot refill supplies until I have only 10 days of supplies left. They must confirm this every time. Visits to the endocrinologist and the associated blood work must be done t…

[Mary47]

Thanks for the info. So, you get your strips from Dexcom also?

[Mary47]

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.

[Mary47]

Thanks. I will start looking at the posts.

[John_S2]

Mary:

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?

[anon31175731]

Mary47 - Yes, Dexcom sends me the the Contour test strips along with my sensors.

[Mary47]

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?

[Dave44]

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).

[Mary47]

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.

[Don1942]

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.

[Dave44]

@Don1942

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.

[Don1942]

Though regular Medicare covers the Dexcom CGMS, Medicare Advantage Plans do not cover any CGMSs.

[Dave44]

ah, mine is a supplemental plan thru AARP. Plan F. thru UnitedHealthcare. It’s been fantastic. No OOP.

[Mary47]

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.

[Don1942]

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.