Continuous Glucose Monitors: Um, How Do I Get One of Those?
There's a new kid in town: the continuous glucose monitor (CGM). Although the technology has existed for nearly 20 years, it has just recently exploded into everyday use by those with diabetes. The information that a continuous glucose monitor provides trumps the information one can get from A1c tests, glucometers, and urine tests.
6 tips to get a continuous glucose monitor
So, it's no wonder people are asking how they can get a CGM. Here are some tips on how to get your hands on a continuous glucose monitor.
1. CGMs covered by insurance and Medicare
Hands down, most insurances will cover a CGM if you take 3 or more insulin shots a day. This includes Medicare. Medicare covers CGMs under Part B (the same part covering meters and test strips). If you're not an insulin user, getting a CGM may be more of a challenge because it comes down to the type of insurance you have.
2. Be prepared to jump through hoops
Some insurance companies will make it hard for people with type 2 diabetes to get a CGM, even if they take insulin. In my experience, state Medicaid programs either will not cover a continuous glucose monitor for you or will make you go through several additional steps and appeals to get one.
3. Your medical provider can help
Your doctor's notes can help. If you're struggling with low blood sugars or have other complications of diabetes, be upfront with your medical provider. Often, these struggles can help push an insurance company to cover a CGM for you.
4. Ask for details
Ask your insurance exactly how a continuous glucose monitor is covered. In my experience, people give up after their insurance denies them a CGM. However, often the CGM was prescribed the incorrect way based on the category of benefit.
Some insurances cover continuous glucose monitors under medical benefits, similar to a cane or other medical equipment. Other insurance companies cover a CGM under the pharmacy benefit.
If your provider sends a prescription to your pharmacy, but insurance only covers a CGM under medical benefits, the prescription could either be denied or very costly. Always ask your insurance provider which category of benefit your continuous glucose monitor coverage applies to. Then, let your medical team know.
5. Pay out-of-pocket for a CGM
It's possible to pay for a CGM out-of-pocket if you truly have no coverage for a CGM. Most CGMs connect to your smartphone and even certain smartwatches. That means you only need the sensor/transmitter pieces. You can decide to use a CGM long-term or short-term if costs are too high. Most companies have programs to help you purchase their equipment out-of-pocket.
6. Borrow a professional continuous glucose monitor
Your insurance may cover a professional CGM, even if they don't pay for a personal one. A professional CGM is borrowed from a medical office, usually an endocrinology office or diabetes center. You use it for several days and then return to the medical office to review your data and return the equipment.
A CGM is a helpful tool
Continuous glucose monitors are an excellent tool for many people living with type 2 diabetes. To best understand your options, talk with your insurance about what is covered, how it's covered, and the specific options available to you.
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