Continuous glucose monitors (or CGMs) can play an important role in managing your type 2 diabetes. By constantly monitoring your glucose levels, CGMs can improve your diabetes management and insulin usage.
In recent years, Medicare coverage has expanded to include more diabetes treatment and prevention tools. Does Medicare cover CGM for type 2 diabetes? The short answer is yes, but you’ll need to meet certain requirements.
We’re here to talk about Medicare diabetes coverage and how to use CGMs in your type 2 diabetes management. Read on to learn everything you need to know about CGMs and Medicare coverage.
A continuous glucose monitor is a piece of medical equipment that tracks your glucose levels throughout the day. It does so by measuring the glucose levels in the interstitial fluid below the skin. A CGM consists of three components:
Some CGM systems also include an insulin pump. The purpose of an integrated insulin pump is to deliver insulin as needed in response to the data collected by the sensor.
Medicare diabetes coverage is expanding. Does Medicare cover CGM for type 2 diabetes? Certain Medicare users do qualify for CGM coverage, so let’s take a look at the specifics of this policy.
While Medicare does now cover CGMs, you will need to meet certain criteria to receive Medicare benefits for CGMs. More specifically, you must meet one of the following requirements:
While your healthcare provider may insert your CGM sensor the first time, CGM systems are designed for constant use. You must also receive thorough training to use your CGM in order to receive Medicare coverage.
There are several different CGM systems available to patients, and only some of them fall under the umbrella of Medicare coverage. For example, your CGM must have FDA approval. It also must come with a stand-alone receiver or insulin pump, meaning that Medicare won’t cover CGMs that rely 100% on a smartphone app to report data.
Currently, approved systems include:
This list may continue to expand over time.
According to AARP, Medicare classifies CGMs as durable medical equipment. As such, CGMs fall under Part B of Medicare coverage.
With Medicare alone, you should expect a 20% copayment on your Medicare-covered CGM system. If you have Medigap coverage, you may have no copay or a smaller copay.
In addition to qualifying requirements, patients will need to meet ongoing requirements to maintain Medicare coverage for their CGM system. For example, you will need to:
Failing to meet all of these requirements can result in having your coverage for your CGM pulled.
Having problematic hypoglycemia may qualify you to receive CGM Medicare coverage whether or not you use insulin to treat your diabetes. Problematic hypoglycemia is defined as:
According to BMJ Open Diabetes Research, around 25% of patients with type 2 diabetes who have been taking insulin for at least five years have hypoglycemia. It is more common for patients with type 1 diabetes and less common overall for diabetics who aren’t using insulin. CGMs will catch both low and high blood sugar, making them a useful tool for diabetic patients who experience both due to hypoglycemia.
Are you a patient who meets the criteria to receive coverage for CGMs under Medicare? Let’s take a look at the additional signs that you may benefit from using a CGM system.
We don’t always understand what causes glucose levels to change in patients with type 2 diabetes. Despite a small lag time, CGMs allow us to track glucose levels 24/7, as opposed to the periodic readings provided by fingerstick testing. Combined with habit tracking, this can help us better understand what naturally impacts your glucose levels.
Studies like this one published by the National Library of Medicine show that patients using CGMs have fewer low blood sugar episodes and a lower A1C. Constant data collection makes it easier to determine when a patient needs insulin (and when insulin is causing hypoglycemic levels). This empowers patients and their doctors to increase glycemic control.
When left unmanaged, diabetes can cause a variety of secondary health problems ranging from diabetic neuropathy to high blood pressure. Many of these secondary conditions stem from blood sugar levels that remain elevated without intervention. By improving glycemic control, CGMs may reduce your chances of developing or worsening secondary health outcomes.
Medicare diabetes coverage has expanded in the past few years. Does Medicare cover CGM for type 2 diabetes? It does for many patients, so make sure to talk to your doctor about the potential benefits of starting continuous glucose monitoring.
Family Medicine Austin is here to help patients over the age of four manage a wide variety of conditions, from diabetes to gastrointestinal disorders. We make it easy for patients to receive healthcare by accepting most major insurance plans, including Medicare. Contact us to book your next appointment and get the care you need.
