Many advantage plans are now covering Dexcom CGM. You have to be persistent when asking as many will tell you they do NOT cover it when in fact, they actually do.
Part of the problem is Dexcom is not selling to Advantage plan members as of yet.
I researched this several months ago but do not know what the current status is as of now. I will see what I can find out.
I agree with Terry. I had nothing but trouble with advantage plansâŚespecially the one AARP advertises.
I have traditional Medicare with Medex Supplemental which is provided by Blue Cross of Massachusetts. I get 5 vials for $ O.00 under Medicare B. Many pharmacyâs donât supply DMEâs under Medicare, so you may have to shop around to find a pharmacist who knows what youâre talking about.
I only take 20 units a day because I had beta cell transplants, so 5 bottles lasts a long time.
In 61 years I have never thrown away a bottle of insulin just because it was more than a month old, and have never had a problem. (Others results may differ) Hope this helps.
Apologies for the OT question, but Iâm curious: How long ago did you have your beta cell transplant @Patricecape? Have you been holding steady at 20U/day for quite a while?
Yes, please tell us about the beta cell transplant. Where do we sign up for that?
Sorry I have not been online for awhile.
I had my transplants at Mass General Hospital, in 2002 + 2003. I stopped taking insulin completely for 2.5 years. Then, as my BG went up, particularly after meals, I started back on multi injection humalog and then back to 10 units Lantus at night and coverage for meals with humalog.
I finally got a pump 3 years ago, and now I have settled out at approximately 20 units of humalog, give or take, between basal and bolus.
I am still producing some insulin 17 years post-transplant.
See above answer. But I know the study I was in has stopped. I think there are other studies but many have moved on to working on alternative. My study was kind of intense with what you had to do to comply with the criteria.
I had to go to Boston weekly for quite awhile, and I live 2 hours away. Then it was monthly, 3 moths, 6 months. You also had to take immunosuppressants for the rest of your life. Several people dropped out because of side effects. Participants had to sign waivers that they realised the medicine could cause cancer etc. So it was a little nerve racking, but here I am 66 yrs old with T1D for 61 years. I never would have believed it.
Itâs part of their business model. For the privilege of a medicare contract they take a loss on pumpers but make it up elsewhere. At the end of a fiscal year, they still have a net gain. Per capita, there really arenât that many T1s, even less who pump and still fewer who pump who have made it to medicare age. More of us are living longer and Medicare will have to adapt to us. In another generation, this will change too.
To be clear, as a former spouse of a Fed employee, I pay the full cost for my insurance. But, since I am part of such a large group, it is affordable to cover everyone regardless of age or pre-existing conditions, and the cost is reasonable.
I am new here, and for first time am on Medicare and a Medicare Supplement. I just got a new T-Slim pump and Dexcom G5. I understand all my supplies are paid for. What I cannot find out is how to get the insulin covered. I do have a Medicare Part D Prescription Drug Plan. Under the Drug Plan the insulin cost is prohibitive. Where and how do you get your insulin and get it covered by Medicare. Will appreciate any info you can provide. Thanks so much.
You tell the pharmacy to cover it under Part B.
This Medicare pamphlet, entitled, Medicare Coverage of Diabetes Supplies & Services, will provide some of the details of Part B vs. Part D insulin and supply coverage.
From the document cited above:
You must get supplies from a pharmacy or supplier thatâs enrolled in Medicare. If you go to a pharmacy or supplier that isnât enrolled in Medicare, Medicare wonât pay. Youâll have to pay the entire bill for any supplies from non-enrolled pharmacies or non-enrolled suppliers.
Even if a supplier is enrolled in Medicare, you will likely run across ignorance on the part of the pharmacy about Part B vs. Part D. I donât know how many times Iâve had to repeat, âIâm talking about Medicare Part B, as in bravo, not Part D as in delta!â
Pharmacists and their technicians are much more familiar with Part D than Part B. Plus I think that Part B payments for insulin are lower than theyâd like or are used to receiving.
Identify a local pharmacy that is enrolled in Medicare and is willing to do the work necessary to set up your Part B claim. Walgreens and CVS pharmacies are hit and miss in this category. You need to cultivate your own local resource. I get my Part B insulin at a CVS pharmacy.
Thank you. So simple.
YW. I try not to be wordy when it serves no purpose. 