Thanks to @Lynn17 saying she was getting her CGM and test strips covered under Medicare I decided to investigate further.
First I knew I could get Optum RX to cover them. But my copay had been higher than I could just buy them myself. But at the beginning of the year it turns out my Optum RX plan has started carrying Contour test strips as their preferred brand and it would only be $40 for 300, or a 3 month supply. That is already a plus, but since Lynn had said they were covering them under Part B, I decided to call. Even though it says online under their guidelines that they are not, I know Medicare can give on certain things if a doctor says it’s necessary. Part B for me would be free because of my Gap insurance.
When I called Medicare I was told if a doctor deems it necessary they would cover test strips and a CGM. They couldn’t see anything where it says they won’t. I then called my Dexcom supplier who said one or the other only. I then called Medicare back and this time they said they are covered when bundled, I said the G6 isn’t bundled the G5 was. The only response I could get was yes they do in a bundle. Okay what …?
Next I contacted my endo/doctor and asked if she knew if I could get them covered under Part B. My doctor was out of town but the NP covering her said yes they could get them covered it just had to be written in such a way to be Medicare compliant. Optum RX doesn’t do Part B, so I had the script sent to Long’s.
And they were covered under Part B. The only slight problem was my doctor only wrote the script for 3 a day for 100 days. 100 days is not allowed so Long’s cut the script to 200 for the 90 days. That’s fine, that works and I will just correct it the next time if I want/need to. The next slight issue is Long’s is not set up to bill more than one entity for Part B. I only paid $6.60 through Medicare for the 200, but I have to fill out a form and send for reimbursement for the $6.60. I called to double check that coverage with my Gap insurance and they said yes they definitely will pay it, it’s just a lot of providers don’t want to bother billing a 2nd entity.
Barring getting some kind of letter from Medicare saying oops, because Long’s did have me sign the Medicare form. It looks like if written correctly Medicare will cover test strips and a CGM. But be beware, lol… your experience may vary as we have had several people saying Medicare won’t or has stopped covering test strips for years now. I am on original Medicare with an added gap insurance. Dexcom G6 and Omnipod.
Having bg meter and strips should be as a backup for failed/failing sensors, or cgm values or trends that don’t match what you expect. Just like having a spare tire in your car.
Marie—You’ve good at jumping through hoops and trying lots of options!
I do not pay anything for my strips or lancets under Part B. (I use a CVS pharmacy and they bill my items directly to Medicare. I get my DexCom cgm sensors from a mail order supplier that my insurance dictates. No bundling.). Medicare is so darn complicated—just a guess, but the patient’s cost for strips might depend upon what type of Medicare plan/supplement the patient has. I am not on original Medicare. The term “Alphabet Soup” when referring to Medicare, is totally appropriate!
At any rate, glad to hear you’re going to be able to get strips! Even with the cgms, we need the strips!
@MM1 I totally agree, my new sensors can start 50-80 points off or be very close to being right. The ones close to being right at onset usually end up off later. And you can’t tell unless you test. Mine also have a tendency to go slowly lower than my actual BG level as time goes on. So I periodically check them. It makes a difference to me when there is a 20 point difference in eating and dosing. It’s the most ridiculous thing to say they don’t need to be checked or calibrated.
Per Dexcom,
No fingersticks, no scanning!
“Dexcom G6 gives you the freedom to manage your diabetes with zero
fingersticks†or calibrations.”
But then they say
“If glucose alerts and readings from Dexcom G6 do not match symptoms or
expectations, use a blood glucose meter to make diabetes treatment decisions.”
Reminds me of the time an internal medicine dr told me type I’s on insulin only need to test once a day, or then there was the time I got in a huge fight with a supplier who said we should not be allowed any spare infusion sets. Yupper.
Whether Medicare will cover CGMs or test strips depends on WHICH CGM you use and which Medicare plan you pay for. I am on the original Medicare plan, and it will pay for my CGM but not for any test strips since, as Marie20 noted above, I use a G6 which supposedly does not need any test strip backups … until it does. So while my plan will cover some things, other Medicare plans may not. And if you call Medicare and talk to two different people, be ready to get two completely different answers to your questions.
