Dexcom CGM Eligible for Reimbursement Under Medicare

Over 23 million Americans are living with diabetes, and with multiple finger sticks each day, it's no surprise that Medicare has finally approved reimbursement for the Dexcom CGM (Continuous Glucose Monitoring). Reimbursement for the Dexcom CGM is significant because the data available can be used to make treatment decisions. 

The Grueling Process of Managing Diabetes 

The method for managing diabetes starts with a finger stick. Use the lancet to get a blood sample for the test strip. Insert the test strip into the glucose monitor. Wait for the monitor to register, then the blood sugar level appears on the screen. Depending on the results, the insulin injections are next.  

Let's not forget the alcohol pads and band-aids that are used throughout the process; Nor disregard the need to dispose of sharps and test strips.  

All that work, and the information provided by the current blood glucose monitor only depicts the blood sugar level at that very minute. Until now, there was no practical way to know if your glucose was going up or coming down. It was impossible to track, and the idea of real time access to trending data was just a pipe dream. 

How the Dexcom Continuous Glucose Monitoring system works 

The Dexcom Continuous Glucose Monitoring system is exactly what the name implies, a system that is continuously monitoring your glucose level.  

The system uses a tiny sensor under the skin that measures blood glucose. The sensor is inserted using the simple auto-applicator provided with the Dexcom CGM. Each sensor is disposable and is replaced about every 7-10 days. This slim sensor continuously measures glucose levels just beneath the skin.  

Once the sensor is inserted under the skin, the one-touch applicator is easily removed, and the transmitter is attached to the sensor. The transmitter is outside the skin and is approximately half the size of a pinky finger.  The transmitter then wirelessly sends the glucose monitoring data to the display device which is also provided with the Dexcom CGM. 

The Dexcom system takes a glucose reading every 5 minutes, which is 288 times a day. The data is displayed on the small touch screen receiver or compatible smart device, providing real-time glucose monitoring.  

This system is equipped with alerts that warn of approaching highs and lows, even through the night. The alert can be shared with up to 5 family members or friends.  

A finger stick is required twice a day to calibrate the device. For most diabetics, two finger sticks a day is a cinch compared to the multiple sticks they are currently enduring. 

Why is Medicare providing reimbursement for the Dexcom CGM  

Continuous Glucose Monitoring with the Dexcom system helps put the patient in charge of diabetes maintenance. Through education and research, patients have taken control of their health and chronic illnesses.  

Diabetes is a chronic condition that has impacted generations and it’s no surprise that drastic changes have occurred since the first blood glucose monitoring system was introduced about 50 years ago.  

As patients have become their own advocates, the insurance companies have heard the voice of the masses and taken the action that has been long overdue. Diabetics want to have an active role in deciding their course of treatment and the Dexcom CGM delivers.  

When patients are engaged in their treatment, they are more likely to take better care of themselves and manage their medical conditions effectively. 

Are you eligible for the Dexcom CGM System 

Everyone with diabetes has been following the progress of the continuous glucose monitoring system and the challenges to get the device covered by insurance.  

Both Medicare and private insurance companies have finally agreed that continuous glucose monitoring is financially practical, and the therapeutic benefits supersede any prior reservations that were based on cost.  

The equipment must be defined as therapeutic, meaning treatment decisions can be made based on the information collected from the device. 

There are a few criteria that need to be met to satisfy Medicare requirements for reimbursement: 

• The Medicare Beneficiary must have diabetes mellitus, type 1 or 2; and 
• The Medicare Beneficiary has been using a home blood glucose monitor (BGM) and testing BGM four or more times a day. 
• The Medicare Beneficiary is using insulin injections at least 3 times a day or using an insulin pump. 
• The Medicare Beneficiary requires frequent adjustments to insulin based on blood glucose monitoring results. 
• The Medicare Beneficiary had a face to face office visit with the ordering physician within 6 months prior to the order for Dexcom CGM. 
• The Medicare Beneficiary must follow up with the ordering physician every six months to document the Dexcom CGM is working for patient and to assess adherence to treatment. 

Why make the switch to the Dexcom Continuous Glucose Monitoring system 

Medicare Beneficiaries are more active than ever before. They want to maintain that lifestyle and to do so, it is necessary to utilize the available technology. The Dexcom CGM can be worn during all activities.  

There is no worry if you are going swimming, Dexcom is water resistant.  Whether you’re a home body or globe trotter, the Dexcom sensor is small and discreet. There are fewer interruptions to daily life with the new Dexcom CGM.  

Many seniors battle mental health issues, coupled with chronic pain, you have two medical conditions that tend to be in a constant battle against each other. It has been proven that pain can affect one’s mental state just as one’s mental state of mind can affect one’s pain and healing process. It is important to get medical attention for both conditions so you can function and perform normal act’s of daily living.

Are Mental Health Service Covered Under Medicare?

Mental health coverage is available under your Medicare Part A and Medicare Part B benefits.

Under your Part A benefits, hospitalization for psychiatric care is covered at 80%. If hospitalized at a general hospital, your mental health care, room and food as well as any other related care is covered. If hospitalized at a psychiatric facility, you receive the same benefits however, Medicare gives you a lifetime limitation of 190 days in this type of facility. 

Under your Medicare Part B benefits, your outpatient mental health visits are included. Any office visits with a psychiatrist, psychologist or clinical social worker would fall under your Part B coverage. Additionally, your Part B benefits may cover diagnostic testing ordered by a provider, annual depression screenings, partial hospitalizations (a structured outpatient program for mental health care rather than inpatient admission), individual and/or group psychotherapy as well as family counseling if medically necessary.

Regardless of whether you’re using Medicare Part A or Medicare Part B, both benefits are only covered at 80%. This leaves the beneficiary responsible for the remaining 20%. Additionally, your deductibles for Part A and B will be required to be paid in advance. You may also be responsible for copays and coinsurance not covered by Traditional Medicare. 

A Supplement Plan can help offset some of these out of pocket (OOP) costs, saving you thousands of dollars in the long run.There are 10 letter plans offered by the various private insurance carriers. Based on your individual needs one will be the right fit for you.

Keep in mind, most mental health conditions normally require prescription drugs for palliative care. Traditional Medicare does not offer medication coverage so you will also want to consider a Medicare Part D Plan. A Part D Plan (PDP) will provide coverage for most medications which could otherwise end up costing you hundreds of dollars each month in OOP costs.

Is Interventional Pain Management Covered by Medicare?

Interventional pain management is the practice in which medication is used invasively to treat pain as an alternative to surgery. Usually, injection based treatments are combined with NSAIDS (Non-Steroidal Anti-Inflammatory Medications), OTC  (Over The Counter) or opioid pain medications, physical or occupational therapy, durable medical equipment (DME) and a home exercise program (HEP). The practice of interventional pain management is given by a specialist and is considered a type of conservative care. Types of pain management include intramuscular, nerve, spine and major joint injections, stem cell treatments, Botox, physical medicine and rehabilitation.

Medicare Part B will cover most but not all, interventional pain management, as this is usually performed in a physician’s office or an outpatient surgery center. In some cases, a patient will be administered a procedure while being hospitalized in which case your Medicare Part A benefits will pick up coverage.

Regardless of inpatient or outpatient interventional pain procedures, Medicare Part A and Medicare Part B will only cover at 80%. This leaves the medicare beneficiary responsible for the remaining 20%. Additionally, you will be responsible for any deductibles, copayments and coinsurance not covered by Traditional Medicare.

Here is another instance in where a Medicare Supplement Plan can help with coverage not covered by your Traditional Medicare benefits. There are a number of plans available in which you can choose that are best suited to fit your individual health care needs.

Additionally, with pain comes required medications. Whether it’s a prescribed NSAID, muscle relaxer, nerve stabilizer, infusion drug, opioid pain medication or in some cases an injectable medication, Traditional Medicare does not offer prescription drug coverage. This is where a Medicare Part D, or a Prescription Drug Plan (PDP), comes in handy. This will include coverage of any oral and in some cases injectable medications.

Information on Florida Medicare for 2018

Florida Medicare Supplemental insurance plans are for those who are enrolled in traditional Medicare, beneficiaries must be covered by Part A and Part B. Medicare covers a large percentage of medical costs, but those who have Medicare are responsible for the financial portion that Medicare does not cover. Medical services and supplies left unpaid is known as a gap or hole in coverage. Supplements can fill in this gap in coverage.

Insurance companies that provide coverage for medical expenses created a product designed specifically for Medicare beneficiaries to help cover the cost of co-payments, coinsurance, and deductibles that are not covered by traditional Medicare. We'll discuss the basics, what's not covered, eligibility & enrollment, carriers, some state healthcare facts and where to go next to enroll.

Florida Medicare Supplement Plans
These plans are great supplemental coverage that fill in the gaps left by Medicare. Original Medicare pays around 80% of your medical bills, leaving you responsible for the remaining 20%. There are 10 plan options, with an additional high deductible plan, all lettered A-N. All plans are standardized by the government, this means that regardless of what plan you decide to go with, the coverage will be the same across all Florida Medicare Supplement insurance companies.

The reason it's important to research the different carriers is because the cost will be different, but the benefits per letter plan will remain the same. Florida Medigap plans monthly premium must be paid directly to the insurance company to maintain coverage.

What's Not Covered

This coverage doesn't pay your Medicare Part B premium nor does it cover prescription drugs. You must purchase a stand-alone Medicare prescription drug plan to cover the expenses that are associated with the cost of your medicine. Historically, some plans that were sold in the past did provide prescription drug coverage, but this is no longer the case. Each plan covers the basic benefits, and differ by adding additional benefits on top of the basic ones.

Eligibility & Enrollment

Individuals who are enrolled in both Medicare Part A and Medicare Part B are eligible to purchase Florida Medicare Supplement plans. The best time to enroll in a plan is during Open Enrollment (OEP). The first day of the month when a person turns 65 or older AND is enrolled in Medicare Part B is when their OEP time frame begins and lasts for 6 months.

Some states don't offer plans to those receiving Medicare benefits under 65, however Florida does. You're able to purchase any of the 10 supplement plans, but there will be a difference in cost compared to those insured who are 65 or older.

During this time, Medicare beneficiaries can purchase supplement plans without having to go through any type of medical screening. Carriers cannot turn a person away due to medical conditions during Open Enrollment. In addition, private insurance companies must charge those with medical issues the same as those without any medical issues. Again, this is only valid during your OEP, after this initial time period different rules will apply.

Medicare Supplement Providers in Florida Rate Determine Factors

Educating yourself on all the different carriers is an important part of making a well-informed decision. The plans are standardized nationwide regarding benefits, but the Medicare Supplement policy, or Medigap, providers in Florida still get to determine the cost based on specific factors such as location, gender, age or if you’re a smoker.

10 Medical Screenings You Should Have in 2018

If you have a New Year's resolution of improving your health, you may want to consider a few medical screenings to expedite the process. Many of these screenings can catch a health problem in the early stages, allowing you to take care of it fast.

Medicare Osteoporosis Screening

If you feel like you're not as tall as you once were, it may not be your imagination. Osteoporosis and other problems with bone mass can cause you to shrink up to two inches per year. When you see your doctor, ask about comparing your vital statistics from 2017 to see if there are significant changes.

Blood Pressure

A blood pressure check takes less than one minute and can help your doctor monitor your risk for stroke, kidney failure, or heart attacks. Blood pressure will often change gradually, so performing this screening annually can help you compare your numbers from previous years and catch any unusual patterns.

Cholesterol

As with blood pressure, cholesterol numbers may sneak up slowly, making this a good test to have performed every year. Not all cholesterol is bad, however. Your doctor will check both your HDL and the LDL levels.

HDL

High-Density Lipoprotein, or HDL, cholesterol is known as the "good" cholesterol. You want this number to be at least 60, as this particular cholesterol destroys the "bad" cholesterol. The more HDL you have, the lower LDL you'll likely have.

LDL

Low-Density Lipoprotein, or LDL, cholesterol is the cholesterol you don't want. This is the fat which sticks to your arteries. You'll want this number to be lower than 120 if you have no other risk factors for heart disease. If you have risk factors, you want it to be less than 100.

Dental Screenings

If you don't have much risk for gum disease, you may be able to have this performed once during 2018. If you have a history of periodontal disease, you'll want to see a dentist every six months. You'll want to see a dentist for more than just dental hygiene, however.

Dentists are able to catch early signs of oral cancer and infections which may cause severe health problems down the road. You can find more information on what dental expenses Medicare covers here.

Cancer Screenings

From mammograms for women to testicular screenings for men, annual cancer screenings are essential for those over the age of 65. They take little time and can provide early warning signs of cancer, allowing you to start treatment as soon as possible.

Vision Checks

Annual eye exams can help detect problems such as cataracts as well as glaucoma, allowing you to see clearly for years to come. In addition to preventing complications such as blindness, annual vision checks can help prevent falls and the associated physical damage which can occur from them.

Hearing Check

An annual check of your hearing can catch signs of hearing loss at an early stage, allowing you opportunities to use hearing aids or other methods of assistance. You don't want to miss your grandchildren singing their favorite songs or talking to you on the phone, so make sure you can hear them clearly.

Diabetes

A yearly check of your blood sugar can detect signs of pre-diabetes as well as signs of Diabetes II. Untreated diabetes can cause kidney failure as well as blood flow problems, so early detection and a healthy diet is key to treatment.

Mental Health

In addition to your physical health, it's a good idea to have a mental health screening performed in 2018. Issues such as depression, anxiety, and mood disorders are not limited to young adults. Screening and treatment can help you enjoy your retirement years without the weight of mental health problems weighing you down. Staying up to date on Medicare and mental health coverage is crucial. 

Cognitive Ability

In addition to mental health, it's a good idea to have a screening to check your cognitive abilities. From memory to intelligence, you want to ensure your mental abilities are not declining with age. This screening can provide early detection of dementia or Alzheimer’s disease.

You're young enough to enjoy your retirement years. Consider taking advantage of these screenings to keep your body and mind healthy for as many years as possible.

Sources:

Health.USNews
Health Benefit Admin

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Medicare Part F Cost & Benefits

Navigating the world of different Medicare “plans” and “parts” can be quite difficult, but if you’ve been asking yourself, “How much does Medicare Part F cost”, you’ve come to the right place. The first thing you should know is that Original Medicare is divided into four parts.

• Part A
• Part B
• Part C
• Part D

You must be enrolled in Part A and Part B in order to be eligible to purchase a Medicare Supplement plan.

Medicare Supplement plans are divided into plans, A through N, and help pay some health costs that are not covered by traditional Medicare.

These are plans sold by private insurance companies, and the best time to purchase them is during your Open Enrollment Period. This period starts automatically the month you turn 65 and enrolled in Part B. Carriers don’t have to accept you if you apply outside of that window.

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