Continuous Glucose Monitor Coverage for Type 1 and Type 2 Diabetes Patients

Who Can Use a Continuous Glucose Monitor?

?There is no doubt that Continuous Glucose Monitors (CGMs) have revolutionized diabetes management for patients of all ages.

?But what exactly is a CGM?

?Can Type 1 and Type 2 diabetes patients use one?

?Is it covered by health insurance? What about Medicare?

?Here we hope to answer many of your questions and show how a Continuous Glucose Monitor can help better manage diabetes. Whether you’re a patient, a healthcare provider or a loved one caring for someone with diabetes, we hope to answer many of these questions.

?What is a Continuous Glucose Monitor?

?For patients who need to keep a closer eye on blood glucose levels, the FDA approved Continuous Glucose Monitor can track levels anytime day or night. A CGM collects data automatically and readings can be taken every five minutes if needed.

?A small electrode that is the size of a quarter is placed under the skin and held in place by an adhesive. A transmitter attached to the electrode sends data to a separate unit allowing a patient to record and access valuable information that allows them to manage and control their diabetes.

?A simple swipe produces a quick reading along with trend data to help patients identify where glucose levels are headed. CGMs can also track where glucose levels have been by providing historical data that tracks daily patterns, ranges and targets. A Continuous Glucose Monitor also alerts patients when levels are trending too high or too low.

Understanding the Difference Between Type 1 and Type 2 Diabetes

?A Continuous Glucose Monitor can be used in both Type 1 and Type 2 diabetes patients. It’s important to understand the difference between the two types to understand why one have better coverage than the other:

?????Type 1 Diabetes – the immune system creates antibodies that destroy insulin producing cells in the pancreas. Insulin is needed for cells to take up glucose. If insulin is lacking, as is the case with Type 1, then this raises blood glucose levels and results in Diabetes. A person living with Type 1 Diabetes requires insulin therapy because they lack the cells needed to produce insulin. Type 1 Diabetes can’t be prevented.?

?????Type 2 Diabetes - Considered to be the more common form of Diabetes, Type 2 occurs when cells in the body become more resistant to the effects of insulin, so less glucose is taken up by the cells. This raises blood glucose. Cells in the pancreas try to produce and release more insulin to overcome this resistance.?Over time, the pancreas can’t produce enough insulin and blood glucose levels remain high resulting in Diabetes. Type 2 Diabetes can be prevented.

?CGMs for Type 1 and Type 2 Diabetes Patients

?It important to note that a prescription is required to receive a Continuous Glucose Monitor which is traditionally prescribed for patients who exhibit the following conditions1:

?????Major fluctuations in blood sugar levels

?????Use an insulin pump or receive multiple insulin injections per day

?????Women who experience gestational diabetes during pregnancy

?While typically prescribed for Type 1 diabetes patients, research is underway to test the benefits of Continuous Glucose Monitors for Type 2 diabetes patients.

?In certain cases, portions of a Continuous Glucose Monitor expense are covered for Type 2 patients who use insulin. It’s important to check with your healthcare provider and insurance company to verify coverage.

?Are Continuous Glucose Monitors Covered for Type 1 and Type 2 Diabetes?

?The answer to this question is a bit ambiguous - it depends. There are many factors that play into this:

?????State of residence?

?????Current insurance plan

?????Severity of the diabetes diagnosis

?????Current age

?????Usage patterns

?????Physician recommendation

?The good news is that most major health insurance plans provide some level of coverage for CGMs when prescribed by a qualifying physician. Some of the major insurance companies that cover Continuous Glucose Monitors are Cigna, United Healthcare, Blue Cross and Blue Shield, Aetna, Humana, and Kaiser.?

And thanks to recent changes, Medicare now covers many CGM brands under the durable medical equipment category. In 2017, Medicare made a change that began to open doors for CGMs and diabetes patients everywhere. “As of October 2020, all CGM devices on the market with the exception of those from Medtronic Diabetes are covered by Medicare. These include the Dexcom G6, the Abbot FreeStyle Libre 1 and 2, and the implantable Eversense CGM from Senseonics.”2

How to Find Out Which Continuous Glucose Monitors are Covered?

Sorting through the coverage and qualification process can be overwhelming. That’s where we can help! At Quest Health Solutions, we can guide you through the entire process. We are not only one of the leading suppliers of Continuous Glucose Monitors in the market today, but we also offer CGM Fulfillment Solutions.?Our experienced team will handle all of the paperwork, insurance and Medicare verification, billing and authorization calls. To learn more or to find out how a Continuous Glucose Monitor can be part of the solution, contact us 1-877-888-7050 Option 3, Ext. 1011, email [email protected] or schedule an appointment today.?

1.???????(2019) WebMD. How Does a Continuous Glucose Monitor Work? Available at https://www.webmd.com/diabetes/guide/continuous-glucose-monitoring accessed on 27 September 2021.

2.???????(2021) Healthline. Medicare Loosening Restrictions for Continuous Glucose Monitor Coverage. Available at https://www.healthline.com/diabetesmine/news-medicare-expanding-cgm-coverage#medicares-history-with-cgm accessed on 27 September 2021.