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.