Sarah Howard
Sarah Howard has worked in the diabetes research field ever since she was diagnosed with T1D while in college in May 2013. Since then, she has worked for various diabetes organizations, focusing on research, advocacy, and community-building efforts for people with T1D and their loved ones. Sarah is currently the Senior Marketing Manager at T1D Exchange.
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If you have transitioned to Medicare from private insurance, did you at first have to go any amount of time without a pump or CGM because you did not meet all of Medicare’s coverage requirements? Cancel reply
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Pump or CGM’s medicare is quite good (except maybe the 5-year pump replacement policy), On test strips, however, medicare was/is/continues to be horrid. ⚡
I transitioned to Medicare at the same time that my insulin pump went out of warranty so I was able to use it during the transition, which was probably a month. I started cgm when I transitioned to Medicare.
I don’t recall going without my pump or CGM when I went on Medicare. But, Medicare does not make health insurance easy. The rules just go on and on to make life more difficult for diabetics.
Medicare stated that I did not require testing 4 times daily, if patient was already using a cgm. Yet DME provider would not fill Dr. Rx unless that Item was also fulfilled. Order required 2 months to fill : > )
I also had difficulty getting pharmacy to bill Medicare for pump insulin under DME provision. only CVS would fill a Medicare pump insulin Rx. no bartell, costco, or rite aid
As i was preparing to transition to Medicare, I thoroughly researched all the plans, including Medicare Supplements and Medicare Advantage. The main thing I was looking for was coverage on my diabetic needs. the Advantage plan I picked was great in every area except one, timeframe for a new pump. My Medtronic pump’s warranty runs out in four years, while Medicare plans only allow replacement after five years. As far as test strips go, they provide one per day which for me is plenty, especially since I have a large supply from my regular insurance days. Although my CGM (Dexcom) doesn’t really need a finger stick I still like to test once a day to ensure it’s on track.
I had a small stockpile of both pump and CGM supplies when I transitioned to Medicare last year. I have gone without sensors, a transmitter and the correct infusion sites because of the DME company I was told I had to use when I first began my Advantage plan. Thanks to the awesome Tandem costumer service representative who called that company and then my insurance, I no longer have to deal with them and I get to work with a DME company that cares if you have the correct products or not.
There’s not much any of us can do about having to wait to order until you only have 10 days left.🤦🏼♀️
I transitioned to Medicare in 2019, and I was appalled at how much more paperwork was required for my Endocrinologist to get a prescription approved by Medicare. Way more than had to be done when I was working and on a Humana health care plan through work. Seems absurd – it’s not like someone with T1D is going to wake up one morning and suddenly not need their pump or CGM!
I am full Medicare age and beyond. I opted to continue working full time to avoid the Medicare horror stories I hear every day. (I’m an RN and work in health care). I imagine I’ll go on Medicare in a year or too. Certainly would love to retire.
It has been awful. The switch from. Direct from manufacturer to DME provider has been maddeningly slow. I am glad I stock piled a few months of supplies. I still have not managed to get insulin under Part B or figured out how to get test strips four months in.
Bob that was my biggest challenge also. This year I asked if I could get fair pricing on my Novolog, as it went $100, OptemRX has now dropped me because I asked and my endocrinologist ask. We thought it was a fair question, Humalog is only $35, why should I have to pay $864 for insulin I’m not allergic to?
I stocked up before going on Medicare. I know Medicare does not cover my current CGM (Guardian 3 from Medtronics ). Even after being diagnosed 27 years ago as Type 1, I also had to schedules a c-peptide and antibody test before they will approve any CGM. Now waiting to see my endo to finish this approval.
I have hospital only on Medicare because I kept my insurance. It is a pain for billing because Medicare has to be billed first, then denied before my insurance is billed marked by me as gross inefficiency in our healthcare system. My supplies continued smoothly but the billing was all messed up and the insurance company refused to pay my medical costs until I straightened it out. I didn’t understand that Medicare needed to be billed first. That first year with the switch was daunting.
I was on the state of Indiana High Risk insurance coverage before going onto Medicare. I don’t have a pump and was not on a CGM at the time but the doors opened up for less costly insurance coverage.
I did not have any trouble during a transition because I was already on Medicare from a disability, but recent changes have made it much more challenging to reorder both pump and CGM supplies with the company I use. I’m wondering if I can choose a different third party supplier as this one wants to keep charging me and I have a zero copy on both devices.
I would think N/A and Never Been on Medicare would be interchangeable and should be noted more specifically. I’m not old enough for Medicare, so I picked N/A, but feel many others might have picked Never been on.
Medicare is my secondary insurance. Primary coverage is thru my wife’s employer. I waited until I was already enrolled in Medicare to start using a pump and had to jump through all of the required hoops , after 60 years w T1, for Medicare to accept any DME claims. After I had the pump, an Animas Vibe, I applied directly to Dexcom for a G5 CGM. That took close to 5 months to be approved by Medicare. Dexcom wouldn’t file claims with both , billing me for the Medicare portion. That led to two years of constant hassles with both Dexcom and Medicare and often left me without CGM supplies. Dexcom eventually wrote off the balance and I now get my supplies through a medical supply company.
Medicare has policies which cause me problems constantly. I use CGM. Their policy is to renew after 31 days when a box lasts 30 days. After a few months I am many days without CGM sensor which is extremely dangerous for me since I am totally hypoglycemic unaware. And since I use a Dexcom G6, they do not cover test strips. For infusion sets they require you to use them for 3 days. I have been using a pump since 1979 so I rotate sites frequently. Some I use get peeled up due to rubbing so I use them for 2 days again causing me to be short. Thankfully, my Dr. provides me a few extra infusion sets or Dexcom Sensors when needed. Finally if on a pump, they require you to use it past the warranty date for a year before they will replace. They obviously do not look out for the patient.
Medicare goes along with the manufacturer’s recommendations for infusion sets. I use Trusteel and the manufacturer recommends changing these every 2 days, which is what I need to do. Medicare pays for 45 every 90 days, no problem.
I had a stockpile of supplies before going on Medicare but used much of my stockpile while waiting for the supplies to start coming. I ended up having to pay for a month of Dexcom’s because they didn’t arrive in time. I didn’t know all the Medicare rules before I began which slowed down the process even more. And neither my endo’s office nurse nor Walgreens staff helped with my confusion.
I had just gone through breast cancer and found changing to Medicare and trying to get my diabetes supplies was much harder.
The current requirements for Medicare pump coverage require you prove you make little insulin or have anti-beta cell antibodies, and also requires you to be re-evaluated every 3 months indefinitely, regardless of medical need or individual circumstances, in order to get pump supplies. This later requirement has no basis in evidence and puts people at risk: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7196863/ . Medicare officials have not been willing to change any of the policies despite being presented with that and a lot of other evidence of adverse effects if the policies.
Maybe if enough voters complain to their US senators and detail the problems these policies cause, they would pressure Medicare to update it policies.