I am Christel from Diabetes Strong and in this video, I’ll be going over
coverage of CGM in the U.S,
so that means I’ll be going over private insurance, Medicare, and Medicaid,
and I’ll help you understand if you qualify for a CGM and how to get it
This video is sponsored by US MED,
US MED is the distributor that I use to get my CGM supplies
I've been living with diabetes since 1997
and I started to use the Dexcom CGM or Continuous Glucose Monitor
about 6 years ago and I really think that it's been one of the most
impactful changes that I've ever made to my diabetes management
as CGM allows me to see my blood sugar readings 24/7
either directly on my phone or on a receiver and the system I have,
which is the Dexcom G6, even will give me alerts
whenever my blood sugar is about to travel out of range, being high or low,
that means that I can be proactive in my care and
actually, act before I go low or high, but unfortunately, not everyone living with
diabetes in the U.S has access to a CGM,
most often because their insurance won't cover, it
but the good news is that a lot has changed recently,
it has now become easier to get approved for CGM
and to get it delivered directly to your door at no extra cost
If you have private insurance, so whether or not that's something you buy yourself
or through an employer, your insurance benefits will explain
whether or not your insurance covers CGM for you,
so it will explain usually, if it covers CGM, which brands, and at what cost
if for example, you have a 20 percent copay,
that means that you'll be paying 20 percent of the price
that your insurance company has negotiated directly with
the CGM manufacturer
if you use a distributor such as US MED,
they will actually reach out directly to your insurance company
and figure out if there is a copay for you and how much it is,
so you can do that even before you sign up with them
I will leave a link to US MED down in the video description
so if you want to learn more about those services, or what a CGM would cost you
just go down there click the link and it'll take you right to this site
now let's talk coverage if you have Medicare
so as of July 18 2021 Medicare finally eliminated the
four-time-daily finger stick requirements for CGM
so that means if you get your health insurance through Medicare,
if you manage your diabetes with Multiple Daily Injections, MDI, or an insulin
pump, and you've been denied coverage for CGM in the past
due to the four-times a day fingerstick requirement
you might now be eligible this is huge, this is huge because about
30 percent of those people who receive healthcare through Medicare
live with diabetes
your out-of-pocket cost will depend on a few different factors
including what your Medicare plan benefits look like,
but instead of spending hours on the phone calling a Medicare representative
I suggest you just reach out to US MED and they can run your insurance for you
and they can let you know how much this will cost you
contacting US MED is super easy just go to USMED.com
and you can either contact them electronically or give them a call
now let's move to CGM coverage if you have Medicaid
Medicaid is the single largest source of health coverage in the U.S,
it provides health insurance for more than 80 million Americans
so it's great that private insurance and Medicare now includes broader coverage
for people living with diabetes who use insulin,
however, that's not quite the case with Medicaid
unfortunately, the coverage for CGM using Medicaid is a little more sporadic
Medicaid coverage differs greatly from state to state which makes
it a little harder to figure out if you're covered for a CGM
and unfortunately a lot of states do not
include CGMs in their Medicaid programs coverage does depend on age though,
any child living with diabetes who's younger than 21 on any Medicaid program,
no matter state can access a CGM,
however, for anyone older than 21 it becomes a little bit more complicated
currently 20 states, and as of 2022 it will be 21 states,
has actually fairly comprehensive coverage for CGMs
for people living with any type of diabetes under their Medicaid programs
22 states only cover CGMs
for people with type 1 diabetes in their Medicaid programs and then
there are 7 states that, they don't really have any published coverage information
exactly who qualifies for CGM in different states varies
so you'll have to reach out to your state's Medicaid program
for the exact eligibility criteria so that you know if you actually qualify
another alternative is just to reach out to US MED, as I talked about before
that's the distributor that I use, and they can reach out to your healthcare
insurance for you and actually figure out if you qualify for a CGM
and what the cost will be
once you know that you qualify for coverage, then what?
neither of the most used CGMs here in the U.S, which would be the Freestyle Libre
and the Dexcom sensors, neither of those delivered directly to customers
you used to be able to get the Dexcom sensors directly from the manufacturer,
so they would deliver directly to you, but they stopped that as of May 2021
so now you have to either get your CGM through a distributor
or directly from your local pharmacy
I get most of my diabetes supplies,
so that would be my insulin and my test strips, from my local pharmacy
however, I can't get my Dexcom CGM there because that pharmacy does
not have an agreement with my insurance company
so I get my Dexcom delivered directly to my door through US MED,
and US MED is a distributor
US MED is located in Florida but they recently
expanded their footprint so they can now service people across most of the U.S
what I like about US MED is that it's super easy to use and it's super convenient,
so if you want to get started with them all you have to do is to go to USMED.com
I’ll leave a link to that up here
and you can either call them or you can fill out their online form
and you can get a free benefit check
you then get assigned a personal customer service rep
who will follow you along your journey
I don't know any other diabetes supply companies that really do that,
so you get assigned one person and that person will basically take it from there
once you decide to get your diabetes supplies from US MED
they'll send you a 90 day supply directly to your home
so for me that's my Dexcom G6 but they also carry the Freestyle Libre
as well as test strips and other medical supplies
and once it's time to reorder they'll automatically send you a reorder reminder,
so no running out of supplies here
you can always log in to the patient portal as well,
and you can you know check up on your orders or you can reorder more supplies
I just got my 90 day supply in the mail so
see I just opened the box here and in this box, there is,
there is three-month supplies or 90-day supplies of my Dexcom G6
so that is one transmitter, one transmitter last three months,
and then three boxes of the sensor this is it, so there are three sensors in each box,
each sensor lasts 10 days on the body, so that's well 30 days
all of that comes directly to my door it's delivered with UPS
and that was my overview of U.S CGM coverage,
how to learn of your cover and how to actually get your CGM
as I mentioned upfront this is a sponsored video,
however, all the views and perspectives are my own and I do use US MED myself
Thank you so much for watching