Medicare Advantage and cgm diabetes monitor

[vic120]

Anyone know about this, I had a couple clients call me

They have Humana MAPD, but have been called by telemarketers saying they can switch them to another MA plan that covers these cgm diabetes monitor, Where they dont have to test blood anymore

But in order to see if they are qualified they would have to be transferred to an agent which they declined, So they don't know which MA covers it

I have called Humana they never heard of it, though I do see it online

Does anyone know which MA covers these?

 

[policywunk]

Anyone know about this, I had a couple clients call me

They have Humana MAPD, but have been called by telemarketers saying they can switch them to another MA plan that covers these cgm diabetes monitor, Where they dont have to test blood anymore

But in order to see if they are qualified they would have to be transferred to an agent which they declined, So they don't know which MA covers it

I have called Humana they never heard of it, though I do see it online

Does anyone know which MA covers these?

They all have to cover under DME.Use to be stricter requirements to get approved but looks like they have made it easier now.

New Medicare Coverage Requirements Make CGMs More Accessible
The diabetes community is celebrating a huge win! Beginning on July 18, 2021, Medicare will permanently eliminate the requirement of the four-time-daily fingerstick in order to qualify for coverage of a continuous glucose monitor (CGM).

This requirement was an unnecessary barrier for Medicare beneficiaries, delaying access to this effective technology for individuals with diabetes.

CGMs provide users with real-time, dynamic information about their blood glucose (blood sugar) levels around the clock and alerts to prevent dangerous high or low glucose levels, leading to better diabetes management and ultimately improved health outcomes. One out of five people on Medicare have diabetes, and the elimination of the fingerstick requirement means Medicare beneficiaries with diabetes will have easier access to this critical technology.

 

[DonP]

Wow another weapon for the phone centers to move people . It never ends . Regular plans now have food cards .So with this diabetes with mapd non low income can get this for free on any plan . Don’t they have to pay 20% for it ?There dr can give them a prescription for this ?

 

[policywunk]

Wow another weapon for the phone centers to move people . It never ends . Regular plans now have food cards .So with this diabetes with mapd non low income can get this for free on any plan . Don’t they have to pay 20% for it ?There dr can give them a prescription for this ?

I believe all MA plans have to cover at least 80% of DME however I have seen non snp plans that cover 100% for DME. and yes it needs to be ordered by physician.

 

[vic120]

Wow another weapon for the phone centers to move people . It never ends . Regular plans now have food cards .So with this diabetes with mapd non low income can get this for free on any plan . Don’t they have to pay 20% for it ?There dr can give them a prescription for this ?

Its a weapon because they are deceitful and act as if its not a benefit they already have

Thanks to Policywunk, Any diabetes client of mine will now know they have access to this

 

[somarco]

Vic, I can't speak for what MAPD does, but original Medicare covers CGM's and pumps under Part B. Insulin is also covered as a B expense plus the "leads" or whatever the electrodes are called.

If your doctor determines that you meet all the coverage requirements, Medicare covers continuous glucose monitors and related supplies for making diabetes treatment decisions, (like changes in diet and insulin dosage).
Therapeutic Continuous Glucose Monitors Coverage

However, its' not ALL monitors or pumps, only certain brands and models are covered as DME.

Dexcom is a name I hear mentioned a lot.

I used to participate in a diabetes forum in an effort to understand more about how Medicare works for insulin dependent diabetics. Learned a lot and made a few friends.

FWIW there are also telemarketers that target diabetics and tell them they will never have to pay for their insulin, test strips or anything through a special program that they offer in conjunction with Medicare.

Go back a few years and the scammers were pushing personal mobility scooters at no charge. It seemed like almost everyone on Medicare had one of these.

https://www.washingtonpost.com/sf/national/2014/08/16/a-medicare-scam-that-just-kept-rolling

Medicare cracked down on this gig and started requiring pre-approval for certain DME, especially the scooters. Other things like stair lifts, walk-in showers, etc also now require pre-approval.

For those who do not know, unlike the managed care world, DME is the only thing that requires pre-approval from Medicare.