New Medicare Coverage Requirements Make CGMs More Accessible
The diabetes community is celebrating a huge win! Beginning on July 18, 2021, Medicare will permanently eliminate the requirement of the four-time-daily fingerstick in order to qualify for coverage of a continuous glucose monitor (CGM).
This requirement was an unnecessary barrier for Medicare beneficiaries, delaying access to this effective technology for individuals with diabetes.
CGMs provide users with real-time, dynamic information about their blood glucose (blood sugar) levels around the clock and alerts to prevent dangerous high or low glucose levels, leading to better diabetes management and ultimately improved health outcomes. One out of five people on Medicare have diabetes, and the elimination of the fingerstick requirement means Medicare beneficiaries with diabetes will have easier access to this critical technology.
What does this mean for you? If you already have coverage for your CGM, great! If you’re looking to get one and receive your health insurance through Medicare, after July 18 there will be a simplified, fingerstick-free approval process. The out-of-pocket cost for your CGM will depend on a few factors, like what your Medicare benefit plan looks like, where you’ll get your device, etc. Talk to your doctor and a Medicare representative (call 1-800-MEDICARE) to determine what it will cost for you.
The effort to remove this requirement was long-championed by the American Diabetes Association. Our advocacy team worked closely with the Centers for Medicare & Medicaid Services (CMS) to remove this long-time barrier for people with diabetes on Medicare. This is a big step forward in expanding access to diabetes technology and great news for the diabetes community!
We will continue to work with other organizations, as well as manufacturers, people with diabetes, health care providers, and policymakers to improve access to necessary medications, devices, and supplies for the diabetes community.
We’re making this happen through our Health Equity Now initiative, which aims to ensure that everyone has the right to equitable health care—no matter your race, income, zip code, age, education, or gender. We understand that health inequality impacts historically underserved Americans, undermining their well-being. Health is a basic human right, for which we will continue to fight.