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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.
In the event you’ve been denied a CGM prior to now, or if you happen to’re simply in search of a smoother, much less time-consuming solution to get your diabetes provides, now could be the time to take motion.
Let me stroll you thru the completely different choices and the way I get my CGM (and different diabetes provides).
This put up is sponsored by US MED.
Who’s eligible for a CGM and what has modified just lately?
I’ve been dwelling 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 vital 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 might be proactive in my care.
However not everybody dwelling with diabetes within the US has entry to CGM, actually because their (personal 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 authorised for a CGM.
CGM protection in case you have personal insurance coverage
Most personal insurance coverage cowl CGM for folks dwelling with diabetes, however you’ll should verify your insurance coverage advantages to see if that’s the case along with your plan, which manufacturers it covers, and at what worth.
Plan protection can change from 12 months to 12 months, so in case you have been denied protection prior to now, it’s value checking up in your plan profit yearly or selecting a plan that covers CGM throughout open enrollment (which is often November by way of January).
Most individuals may have some form of copayment when utilizing a non-public insurance coverage plan. In the event you, for instance, have a 20% co-pay, that signifies that you’ll pay 20% of the value your insurance coverage plan has negotiated with the CGM producer.
In the event you use a distributor to your medical provides, comparable to US MED that I’m utilizing, they’ll contact your insurance coverage firm for you, earlier than you even enroll with them, to search out out if you happen to’re lined and what your co-pay is.
CGM protection in case you have Medicare
Over 62 million persons are enrolled in Medicare within the US and about 30% of these folks stay with diabetes.
There are a number of standards an individual has to satisfy to be eligible for a CGM by way of Medicare, however a redundant barrier to protection was eliminated just lately which ought to make it simpler to get protection for CGM.
This barrier was eliminated originally of July 18, 2021, the place Medicare eradicated the four-time-daily fingerstick testing requirement for CGM protection.
So in case you have been denied protection prior to now since you didn’t manually verify your blood sugar 4 instances each day, now could be the time to re-apply for CGM protection.
To be eligible for protection by way of Medicare, you continue to have to satisfy these standards:
- You could stay with diabetes
- You must handle your diabetes with a number of (three or extra) each day insulin injections (MDI) or an insulin pump
- You could require frequent insulin self-adjustment primarily based on the CGM or finger sticks
- You could have seen a medical skilled in particular person inside 6 months previous to ordering the CGM
- You could see the prescribing medical skilled in particular person each 6 months following the preliminary prescription of the CGM
Your out-of-pocket price to your CGM will rely upon what your Medicare profit plan appears to be like like. However as a substitute of spending hours on the telephone attempting to get by way of to a Medicare consultant, another 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 may contact them electronically or give them a name.
CGM protection in case you have Medicaid
Though it’s nice that the majority personal insurance coverage and Medicare now covers CGM for extra folks dwelling with insulin-dependent diabetes, sadly, Medicaid protection is a little more sporadic.
Medicaid is the one largest supply of well being protection in the USA, offering medical health insurance to greater than 80 million People.
Medicaid overage differs tremendously from state to state which makes it more durable to determine if you happen to’re lined, and sadly many states don’t cowl CGMs of their Medicaid packages.
Anybody dwelling with diabetes below the age of 21 on any Medicaid program qualifies for a CGM, however for anybody older than 21, it turns into a bit extra difficult.
20 states (21 in 2022) presently have pretty complete Medicaid protection of CGM for folks dwelling with any kind of diabetes, whereas 22 states solely have protection for folks dwelling with kind 1 diabetes and seven states haven’t any revealed protection.
Who qualifies additionally differs from state to state with most states requiring prior authorization from a physician, however you’ll should verify along with your state’s Medicaid program for particular eligibility standards, or attain out to a distributor comparable to US MED.
In the event you determine to get a CGM, whether or not it’s by way of your insurance coverage otherwise you determine to go forward and pay for it your self, you’ve gotten completely different choices with regards to supply.
Neither of essentially the most continuously used CGM manufacturers, being Dexcom or Freestyle Libre, promote on to the consumer. You used to have the ability to get your CGM straight from Dexcom right here within the US, however they discontinued that utterly in Might 2021.
That signifies that you must use a distributor or get your CGM out of your native pharmacy (in the event that they carry it). I often 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 evaluations 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 web kind or name them for a free advantages verify. You’re then assigned a private customer support rep, a characteristic I don’t know of every other diabetes provides firms which have, and that rep takes care of you from there.
When you determine to get your provides (which for me is my Dexcom CGM, however once more, in addition they ship FreeStyle Libre CGM, take a look at strips, and different medical gadgets), they’ll present free transport of your 90-day provide on to your property with UPS.
When it’s time to reorder, you are able to do it simply over textual content message, the web portal, or over the telephone. It solely takes seconds!
They’ll even offer you 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 may all the time check out your account by logging into the affected person portal. The portal is useful as a result of it retains all your information in a single place. You monitor transport and see all your earlier orders in a safe on-line setting.
It additionally saves you time from having to name in in case your private information has modified, like deal with, insurance coverage protection, or doctor’s identify.
So if you happen to’re contemplating a CGM or are in search of an awesome answer to have your 90-day provides delivered on to your door, I recommend you give US MED a name to be taught if you happen to qualify for a CGM, what your out-of-pocket prices will likely be, and to arrange your subsequent supply.
