Medicare Benefits: Does Medicare Cover Diabetes Supplies | US MED

At US MED^®, our goal is nothing less than to be the nation’s best provider of diabetes supplies. That commitment to quality goes beyond our wide selection of products and unmatched customer service. In addition to accepting 900+ private insurance carriers, we accept Medicare and can even directly bill Medicare for eligible items. Additionally, US MED is one of the few providers to send a 90-day supply to Medicare beneficiaries. That means you only need to reorder four times a year, versus twelve.

However, understanding the ins and outs of Medicare coverage can be confusing for anyone. Read on for a complete breakdown of how Medicare requirements and benefits apply to the products sold by US MED^®.

Does Medicare Cover Continuous Glucose Monitors

The Centers for Medicare and Medicaid Services (CMS) has expanded coverage for continuous glucose monitoring (CGM) devices for people with diabetes. This means that more people with diabetes will now be able to access this important technology, which can help them better manage their condition.

Previous Coverage Requirements

Prior to the expansion, Medicare Part B beneficiaries who used a CGM device had to meet with their doctor in person to get a prescription and again whenever they needed refills. They were also required to perform four manual blood sugar fingerprick tests per day to maintain coverage for CGM therapy.

New Coverage Requirements

The new coverage requirements are more flexible and easier to meet. Under the new policy, CGM coverage is extended to T1D and T2D patients who treat their diabetes with insulin. There are no longer any fingerstick requirements. Additionally, non-insulin-using individuals with diabetes can use Medicare for CGM coverage if they have a documented case of “problematic hypoglycemia.”

How Do the New Medicare Requirements Affect Me

If you have diabetes and are considering using a CGM device, the new coverage requirements make it easier than ever to get started. You can talk to your doctor about whether a CGM is right for you, and they can help you get a prescription.

It’s important to note that private insurers take their coverage cues from CMS, so if you haven’t qualified for a continuous glucose monitor in the past, now’s the time to give us a call to see if these expanded requirements will work for you.

Easy Steps for Medicare Beneficiaries to Get Coverage for CGM

Follow these steps for Medicare coverage of continuous glucose monitors:

• Be diagnosed with type 1 or type 2 diabetes.
• Be taking insulin or meet the hypoglycemia requirements.
• Have a doctor write a prescription for a CGM.
• Have a doctor conclude that you or your caregiver has sufficient training using the glucose monitor.
• Choose a CGM that comes with a receiver or reader. You can also choose a CGM that is integrated with an insulin pump.
• Contact your Medicare Part B carrier to see if you qualify for coverage.
• If you qualify, you will pay 20% of the cost of the CGM.

Here are some additional things to keep in mind:

• Medicare only covers CGMs that are prescribed by your doctor for use in your home.
• Medicare Part B will typically pay for 80% of the CGM.

You may have to meet certain other requirements, such as having regular in-person visits with your doctor.

Dexcom G6, G7, and FreeStyle Libre 2 Are Covered by Medicare

Medicare covers the FreeStyle Libre 2 system, which builds on the original system by adding glucose level alarms and digital communication with other devices. However, the latest CGM from Abbott, the Freestyle Libre 3, is not currently covered by Medicare. As mentioned above, Medicare requires CGMs to include a reader, which the FreeStyle Libre 3 system does not currently include. The makers of the FreeStyle Libre 3 received FDA approval for a reader, so expect this device to be covered in the near future.

Dexcom's CGM are covered; you can get Medicare coverage for the Dexcom G6 CGM System and the new Dexcom G7 System.

Are Diabetes Testing Supplies Covered by Medicare?

Traditional blood sugar monitors, test strips, lancets, and control solutions are all covered under Medicare Part B. If you’re a Medicare patient with diabetes who uses insulin, you can get up to 300 lancets and 300 test strips every three months.

Medicare patients with diabetes who don’t use insulin can still get these products, but not in the same amount. Instead, they’re eligible for 100 lancets and test strips in a three-month period. (However, you can increase your coverage without using insulin if your doctor says it’s a medical requirement and you provide extra documentation.)

The True Metrix Air, Prodigy AutoCode, and Embrace glucose meters are all covered by Medicare and available from US MED^®. We also sell test strips and control solutions compatible with these meters.

Insulin Pumps Covered by Medicare

If you need a tubed insulin pump (i.e., an insulin pump you wear outside your body), it may be covered under Medicare Part B if you have diabetes and meet certain conditions. The same holds true for the insulin used to fill these pumps. Under Original Medicare, you’ll need to pay 20 percent of the amount approved by Medicare for these products after your annual Part B deductible. Medicare will cover the remaining 80 percent.

Medicare Part B covers the Tandem t:slim X2. Meanwhile, tubless options including the Insulet OmniPod, OmniPod DASH, and the brand new Omnipod 5 are covered under Medicare Part D. Of course, all of these insulin pump options are available from US MED^®!

Smart Insulin Pens, Insulin Pen Needles, and Syringes

Devices used to administer insulin- including insulin pens, needles, and syringes - are covered under Medicare Part D for Medicare patients with diabetes. One unique product in this category available from US MED^® is the InPen, a “smart insulin pen” that offers personalized recommendations for insulin dosage. Along with that, we carry needles and syringes in various sizes.

Does Medicare cover CPAP Masks and Sleep Apnea Supplies

While obstructive sleep apnea and insulin resistance may be linked, not all people with diabetes on Medicare are eligible for CPAPs and related accessories. First, you’ll need to be diagnosed with obstructive sleep apnea; in that case, Medicare may cover a three-month CPAP trial. If your doctor finds that this therapy improves your condition, Medicare could also cover CPAP supplies in the long term.

Are you living with diabetes and sleep apnea? If so, explore US MED^®’s selection of CPAP accessories. We sell nasal pillow masks, nasal masks, and full-face masks for CPAP users.

If you’re still wondering about Medicare coverage for US MED^® products, we’d be happy to help! Give us a call at 1-877-840-8218 to discuss this topic or any other questions you may have.