UPDATE: The refill 4 months later was turned down as not covered under Part B. I did get them covered under my Part D.
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.
So no rhyme or reason… change of rules or someone looked at it differently, it was absorbed into the system or??? Medicare had told me they would be covered, my doc wrote the script and the test strips were covered.
So the first time the test strips were covered under Part B, 3 months pass and time for a refill. Put through the refill request and they were turned down because I already have a CGM being covered.
So I will go back to the Part D route which worked fine before, as long as it does now…
Hi Marie. Medicare has been furiously revising the Glucose Monitor Policy and LCD recently. Probably not the cause of the denials but worth reading if you haven’t seen the latest versions. Check the denial, did they code the test strips the same as the time it was approved?
If you want the details:
Article - Glucose Monitor - Policy Article (A52464)
The supply allowance for supplies used with a CGM system (A4238, A4239) encompasses all items necessary for the use of the device and includes but is not limited to, CGM sensors and transmitters. For non-adjunctive CGMs, the supply allowance (A4239) also includes a home BGM and related supplies (test strips, lancets, lancing device, calibration solution, and batteries), if necessary. Supplies or accessories billed separately will be denied as unbundling.
LCD - Glucose Monitors (L33822)
Claims for a BGM and related supplies, billed in addition to a non-adjunctive CGM device (code E2103) and associated supply allowance (code A4239), will be denied.
If you have a tubed pump the code might be different, check the External Infusion Pump LCD
This ruling indicates that the supplier of your CGM is responsible for providing a meter and strips if you request it. The problem is that it is a cheap cr*p meter of the supplier’s choice, not the meter and strips that most of us would want. No idea what happens if you get your sensors at a pharmacy which carries name brand strips that many of us use.
I continue to use a Contour Next meter when needed and am able to get an OTC package with 70 strips for about $26 at Amazon or Walmart. My experiences with off-brand meters including Walmart Relion meters have not been good. Whether it is scientific fact or personal bias, I can only use a meter that I trust and am glad to get Contour Next strips for a reasonable cost.
My Medicare is the same as yours, SherryAnn. I was told several times by different agents that either test strips or CGMs are covered, but not both. It’s one or the other. I have my first ever CGM on its way to me and thankfully, have leftover test strips from my last order. When I run out, I will have to buy them out of pocket. It’s frustrating since I have original Medicare plus a supplement and drug coverage. The people that make these decisions don’t understand type 1 diabetes at all, or worse, don’t care.
I’m not seeing that you have to use the same vendor for your CGM and BGM. Can you please reference a doc with that info, I’m trying to learn as much as I can.
When they say bundle, it means the items come together, which means from the same supplier within the same shipment/billing. It says supplies billed separately will be denied as unbundling. The G5 when they shipped the CGM sensors they included test strips with the shipment. That changed with the G6. I have always thought that Dexcom sold the G6 to be accepted by Medicare because they wouldn’t have to supply BGM/test strips. “Supposedly” you don’t have to test with the G6, but even Dexcom says when in question test. But with what then? And if you did manage to get your CGM supplier to send you strips, then it would be the cheapest they bargained to get to supply, not your choice, because I’m pretty sure Medicare isn’t planing on paying extra to supply them, hence the “bundling together”.
A note here. When I called Medicare before and quoted the above paragraph to them last year. I got differing answers. They change their guidelines constantly, but you also pretty consistently get different answers from different people.
But I was able to get test strips of my choice through Part D before. I will try that route again.
Thank you, I see where I went wrong. To expand on what @Laddie said. suppliers are paid a fixed price for A4239 and they can only bill for it once a month. So for them supplying a BGM and supplies in addition to the CGM cuts into their CGM profits which encourages suppliers to stock cheap junk BGMs and supplies.
Back to Marie getting test strips, have you asked your CGM supplier if they carry the test strips you use?
Medicare has rules about Part D not covering something if its covered under part B that shows up in the policies for covering insulin for pumps. Dunno if that applies to test strips also. Enforcement of such rules is spotty at best but is slowly improving.
@spdif When I called my CGM supplier last fall, they said Medicare does not cover test strips and your CGM. I did not try to have my doctor send in a script for test strips from them, they do supply them. But it pretty much sounded like a wall.
Sure enough Optum is saying they will fill the order, but it’s a week too soon. Sigh, I don’t need them, but that week is only because Long’s who was filling it under Part B and it was turned down, decided on their own to submit 50 strips under Part D to see if it went through. Optum who administers my Part D is seeing a claim so that is tying up the order until the 19th or until it drops off as not being picked up. I could get Long’s to remove it, but it’s not worth the effort for a week’s wait.
I have not heard of Part D plans covering test strips so you seem to be lucky to be getting that coverage. Do you have a retiree plan or something that makes you “special” compared to the rest of us? Whatever, glad this seems to work for you.
@Laddie It is a retiree plan through my husbands past employer. They have always covered them, (knock on wood) it’s just the cost can vary as to whether it’s worth getting it through them. I hadn’t heard that Part D plans didn’t usually cover test strips! They used to cover Verio Ultra Touch the cheapest, which I have used too, but nicely last year they changed to Contour being the cheapest. But depending what brand and especially the quantity, it’s not always worth getting test strips through them. I used to buy Contour test strips off the internet cheaper.
I saw @DrBB say ContourNext test strips were OOP in another topic.
@DrBB If your CGM supplier also stocks ContourNext test strips they should be able to provide them with your CGM, the usual stack of properly filled out Medicare paperwork requirements apply. This changed in 2023. Note I haven’t seen anyone say they have successfully gotten then strips covered under Part B since the LCD changed and I’m not on medicare yet so take my optimism with a salt lick.
