Medicare coverage for diabetes monitors is a vital component of diabetes management, particularly for those in North Carolina. From Continuous Glucose Monitors (CGMs) to blood glucose monitors, understanding the nuances of Medicare and Medicaid coverage can significantly impact healthcare costs and accessibility. Explore the evolving landscape of diabetes monitoring options and how they can enhance patient care.
Understanding Medicare Coverage for Diabetes Monitors
Diabetes management is a critical aspect of healthcare, especially for individuals relying on Medicare in North Carolina. Continuous Glucose Monitors (CGMs) and blood glucose monitors are essential tools for managing diabetes effectively. Medicare provides coverage for these devices under specific conditions. To qualify for CGM coverage, a doctor must prescribe the device, and the patient must either be on insulin or have a history of hypoglycemia (source). This coverage falls under the category of durable medical equipment (DME), and patients may need to rent or buy the equipment, depending on the type. It’s crucial for patients to ensure that their healthcare providers and suppliers are enrolled in Medicare to avoid additional costs.
Medicare Part B and Diabetes Monitors
Medicare Part B covers blood glucose monitors prescribed for home use, which is particularly relevant for individuals managing diabetes in North Carolina. Coverage can vary, with options to rent or buy the equipment, and some items may become personal property after a certain number of rental payments (source). After meeting the Part B deductible, patients are responsible for 20% of the Medicare-approved amount if their supplier accepts assignment. This is an important consideration for budgeting healthcare expenses. Additionally, patients should be aware that extra costs may arise if a healthcare provider performs tests or services not covered by Medicare during the same visit.
Changes in North Carolina’s Medicaid Coverage
In North Carolina, there have been significant changes in how therapeutic CGM products are accessed and billed under NC Medicaid and Health Choice. As of July 1, 2020, coverage for these products transitioned from the Durable Medical Equipment Program to the Outpatient Pharmacy Point of Sale Program (source). This transition includes therapeutic CGM products being added to the NC Medicaid and Health Choice Preferred Drug List, with specific models like the Dexcom G5 and G6 being preferred options. Pharmacies in North Carolina are advised to maintain adequate inventory to meet the demand from beneficiaries, ensuring uninterrupted access to necessary diabetes monitoring supplies.
Exploring the Eversense 365 CGM System
The Eversense 365 CGM system is another option for continuous glucose monitoring, covered by Medicare for individuals with diabetes who are on insulin or have a history of low blood glucose events (source). To qualify, patients must have diabetes, be on insulin, or have a history of low blood glucose, and have been trained to use a CGM. The system is designed to replace fingerstick blood glucose measurements, providing a more convenient and less invasive option for diabetes management. While the Eversense PASS® program offers additional savings for those with commercial insurance, it is not applicable to Medicare. However, the program highlights the affordability options available for those with different types of insurance coverage.
Why You Should Learn More About Medicare Coverage for Diabetes Monitors Today
Understanding Medicare coverage for diabetes monitors is crucial for effective diabetes management, especially for those in North Carolina. With the right information, patients can maximize their benefits and minimize out-of-pocket expenses. By ensuring that healthcare providers and suppliers comply with Medicare requirements, individuals can access the necessary tools for managing their condition. Additionally, staying informed about changes in Medicaid coverage and exploring different CGM systems like the Eversense 365 can provide more options for effective diabetes management. Learning more about these coverage options can empower patients to make informed decisions about their healthcare needs.