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I’m qualified for the Continuous Glucose Monitor (CGM) and last year it has changed dramatically how I get it.
If you’ve been denied CGM in the past, or are looking for a smoother, longer-consuming way to get a supply of diabetes, now is the time to take action.
We’ll explain the various options and how you can get CGM (and other diabetes supplies).
This post is sponsored by US Med.
Who is CGM qualified and what has changed recently?
I have been living with type 1 diabetes since 1997 and started using Dexcom continuous glucose monitors about six years ago, and I think it was one of the most powerful improvements in diabetes management.
CGM can view blood glucose readings on your phone or receiver 24/7, and can warn you that your blood glucose will start to get too high or low and you can become more aggressive in your care.
However, not everyone living with diabetes in the US has access to CGM. It’s often because their (private or government) insurance doesn’t cover it. But the good news is that a lot has happened and it has made CGM approval easier.
If you have private insurance, CGM coverage
Most private insurance plans cover CGM for diabetics, but you need to check your insurance benefits to see if it’s your plan.
Plan coverage can change year by year, so if you have previously denied coverage, it is worth checking out your plan benefits annually.
Most people will have some kind of self-payment when using a private insurance plan. For example, if you have a joint payment of 20%, it means that your insurance plan will pay 20% of the price you negotiated with the CGM manufacturer.
If you use a distributor for medical supplies such as US medical supplies I use, they will contact your insurance company before you sign up with them to find out if you are covered and what your co-pay is.
If you have Medicare, use CGM coverage
Over 62 million people are enrolled in Medicare in the US, and about 30% of those people live with diabetes.
There are several criteria that a person must meet to qualify for CGM through Medicare, but recently redundant barriers to compensation have been removed, making CGM compensation easier.
This barrier was removed early July 18, 2021, with Medicare eliminating the four-day finger testing requirement for CGM coverage.
Therefore, if you have been denied compensation in the past because you did not manually check your blood sugar levels four times a day, now is the time to reapply for CGM coverage.
You must meet these criteria to qualify for coverage through Medicare.
- You need to live with diabetes
- Diabetes should be managed with multiple (more than three) daily insulin injections (MDI) or insulin pumps
- Insulin self-regulation is often required based on CGM or fingerstick
- You must have met a medical professional in person within 6 months before ordering a CGM.
- You should see a prescription medical professional in person every 6 months after your first prescription for CGM
The out-of-pocket cost of CGM depends on the appearance of your Medicare benefit plan. But instead of spending time on the phone trying to reach Medicare representatives, another option is to reach out to us and have them do the numbers.
It’s very easy. You can contact usmed.com and contact us electronically or make a call.
If you have Medicaid, please visit CGM Coverage
It’s great that most private insurance plans and Medicare cover CGM for more people living with insulin-dependent diabetes, but unfortunately, Medicaid coverage is a little more sporadic.
Medicaid is the only health source of the largest health insurance in the United States, offering health insurance to over 80 million Americans.
Medicaid excess varies widely from state to state, making it difficult to figure out whether you are covered or not, and unfortunately many states do not cover CGM with their Medicaid programs.
Diabetics under the age of 21 under the Medicaid program are eligible for CGM, but for those over the age of 21, it becomes a little more complicated.
20 states (21, 2022) currently have a fairly comprehensive Medicaid coverage of CGM for people living with all types of diabetes, but 22 states only cover type 1 diabetes patients, and are not publicly available to seven states.
Also, while who differs from state to state, most states require prior permission from a physician, you must check with your state’s Medicaid program for specific eligibility criteria or contact a distributor such as US MED.
If you decide to get CGM, whether through insurance or you decide to go ahead and pay yourself, there are a variety of options when it comes to delivery.
The most frequently used CGM brands, Dexcom and Freestyle Libre, do not sell directly to users. Previously, we were able to get CGM directly from Dexcom in the US, but in May 2021 we stopped it altogether.
This means you will need to use a distributor or get CGMs from your local pharmacy (if they are carried). I usually get diabetes supply and insulin from my local pharmacy, but they don’t carry Dexcom, so I get CGM from US Med, the distributor.
US Med is a certified national distributor of CGM, diabetes testing products, insulin pumps and more. With changes to the standards of eligibility, they will accept hundreds of private insurance providers and Medicare. We also receive great reviews on Google and Facebook!
What I love about our medicine is that it’s so easy to use and very convenient. Visit the US Med website and fill out an online form or call for a free perk check. A personal customer service representative will then be assigned. This is a feature that you don’t know about companies owned by other diabetes companies, and the person in charge will take care of you from there.
If you decide to get your supplies (for me, my Dexcom CGM, but again, they will offer freestyle Libre CGMs, test strips, and other medical devices).
When it’s time to reorder, it can be done easily via texting, online portal or by phone. It only takes a few seconds!
You can also provide automatic reorder reminders for texts, emails, phone calls, and more. So always remember to reorder your diabetes supply.
It’s extremely easy and you can always check your account by logging in to the Patient Portal. The portal is useful because it keeps all your records in one place. Track your delivery and check all previous orders in a secure online environment.
It also saves you time if you have to call if your personal information changes, such as your address, insurance coverage, or your doctor’s name.
So, if you are considering CGM or looking for a great solution to deliver 90-day supply directly to your door, we recommend calling to learn if you are eligible for CGM, what your out-of-pocket costs are, and whether you want to set up your next delivery.
