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Who’s eligible for a Steady Glucose Monitor (CGM) and how one can get one has modified loads within the final 12 months.
When you’ve been denied a CGM up to now, or in case you’re simply on the lookout for a smoother, much less time-consuming method to get your diabetes provides, now could be the time to take motion.
Let me stroll you thru the totally different choices and the way I get my CGM (and different diabetes provides).
This submit is sponsored by US MED.
Who’s eligible for a CGM and what has modified lately?
I’ve been residing with kind 1 diabetes since 1997 and began utilizing the Dexcom Steady Glucose Monitor about 6 years in the past, and I believe it has been one of the highly effective enhancements to my diabetes administration.
The CGM permits me to see my blood sugar readings 24/7 on my telephone or a receiver and alerts me if my blood sugars begin to go too excessive or low so I will be proactive in my care.
However not everybody residing with diabetes within the US has entry to CGM, actually because their (non-public or authorities) insurance coverage gained’t cowl it. However the excellent news is that loads has occurred and it has now change into simpler to be permitted for a CGM.
CGM protection if in case you have non-public insurance coverage
Most non-public insurance coverage cowl CGM for folks residing with diabetes, however you’ll should examine your insurance coverage advantages to see if that’s the case together with your plan, which manufacturers it covers, and at what value.
Plan protection can change from 12 months to 12 months, so if in case you have been denied protection up to now, it’s price checking up in your plan profit yearly or selecting a plan that covers CGM throughout open enrollment (which is normally November by means of January).
Most individuals may have some type of copayment when utilizing a non-public insurance coverage plan. When you, for instance, have a 20% co-pay, that signifies that you’ll pay 20% of the worth your insurance coverage plan has negotiated with the CGM producer.
When you use a distributor on your medical provides, comparable to US MED that I’m utilizing, they are going to contact your insurance coverage firm for you, earlier than you even join with them, to seek out out in case you’re coated and what your co-pay is.
CGM protection if in case you have Medicare
Over 62 million individuals are enrolled in Medicare within the US and about 30% of these folks reside with diabetes.
There are a number of standards an individual has to satisfy to be eligible for a CGM by means of Medicare, however a redundant barrier to protection was eliminated lately which ought to make it simpler to get protection for CGM.
This barrier was eliminated firstly of July 18, 2021, the place Medicare eradicated the four-time-daily fingerstick testing requirement for CGM protection.
So if in case you have been denied protection up to now since you didn’t manually examine your blood sugar 4 instances each day, now could be the time to re-apply for CGM protection.
To be eligible for protection by means of Medicare, you continue to have to satisfy these standards:
- You will need to reside with diabetes
- It’s a must to handle your diabetes with a number of (three or extra) each day insulin injections (MDI) or an insulin pump
- You will need to require frequent insulin self-adjustment primarily based on the CGM or finger sticks
- You will need to have seen a medical skilled in individual inside 6 months previous to ordering the CGM
- You will need to see the prescribing medical skilled in individual each 6 months following the preliminary prescription of the CGM
Your out-of-pocket price on your CGM will rely on what your Medicare profit plan seems like. However as an alternative of spending hours on the telephone attempting to get by means of to a Medicare consultant, an alternative choice is to simply attain out to US MED and have them run the numbers for you.
It’s tremendous simple, simply go to USMED.com and you’ll contact them electronically or give them a name.
CGM protection if in case you have Medicaid
Though it’s nice that the majority non-public insurance coverage and Medicare now covers CGM for extra folks residing with insulin-dependent diabetes, sadly, Medicaid protection is a little more sporadic.
Medicaid is the only largest supply of well being protection in america, offering medical health insurance to greater than 80 million People.
Medicaid overage differs vastly from state to state which makes it more durable to determine in case you’re coated, and sadly many states don’t cowl CGMs of their Medicaid applications.
Anybody residing with diabetes beneath the age of 21 on any Medicaid program qualifies for a CGM, however for anybody older than 21, it turns into a bit extra sophisticated.
20 states (21 in 2022) at the moment have pretty complete Medicaid protection of CGM for folks residing with any kind of diabetes, whereas 22 states solely have protection for folks residing with kind 1 diabetes and seven states don’t have any printed protection.
Who qualifies additionally differs from state to state with most states requiring prior authorization from a health care provider, however you’ll should examine together with your state’s Medicaid program for particular eligibility standards, or attain out to a distributor comparable to US MED.
When you resolve to get a CGM, whether or not it’s by means of your insurance coverage otherwise you resolve to go forward and pay for it your self, you could have totally different choices in terms of supply.
Neither of essentially the most often used CGM manufacturers, being Dexcom or Freestyle Libre, promote on to the consumer. You used to have the ability to get your CGM immediately from Dexcom right here within the US, however they discontinued that fully in Might 2021.
That signifies that you need to use a distributor or get your CGM out of your native pharmacy (in the event that they carry it). I normally get my diabetes provides and insulin from my native pharmacy however they don’t carry Dexcom so I get my CGM from US MED, which is a distributor.
US MED is an accredited nationwide distributor of CGMs, diabetes testing provides, insulin pumps, and extra. With the change in insurance coverage {qualifications} standards, they settle for 100s of personal insurance coverage suppliers and Medicare. Additionally they get nice opinions on Google and Fb!
What I like about US MED is that it’s really easy to make use of and really handy. You merely go to the US MED web site and both fill out the net type or name them for a free advantages examine. You might be then assigned a private customer support rep, a characteristic I don’t know of another diabetes provides corporations which have, and that rep takes care of you from there.
When you resolve to get your provides (which for me is my Dexcom CGM, however once more, additionally they ship FreeStyle Libre CGM, check strips, and different medical units), they’ll present free transport of your 90-day provide on to your own home with UPS.
When it’s time to reorder, you are able to do it simply over textual content message, the net portal, or over the telephone. It solely takes seconds!
They’ll even provide you with automated reorder reminders like textual content, e mail, or calls so all the time keep in mind to reorder your diabetes provides.
Tremendous simple, and you’ll all the time investigate cross-check your account by logging into the affected person portal. The portal is useful as a result of it retains your entire data in a single place. You monitor transport and see your entire earlier orders in a safe on-line setting.
It additionally saves you time from having to name in in case your private data has modified, like tackle, insurance coverage protection, or doctor’s identify.
So in case you’re contemplating a CGM or are on the lookout for an excellent answer to have your 90-day provides delivered on to your door, I counsel you give US MED a name to be taught in case you qualify for a CGM, what your out-of-pocket prices shall be, and to arrange your subsequent supply.
