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Re: [IP] Medicare Enrollment and CGM coverage



>Date: Wed, 26 Oct 2011 07:31:49 -0700 (PDT)
>From: Jerry Smith <email @ redacted>
>Subject: [IP] Medicare Enrollment and CGM coverage
>
>How is everybody doing with their Medicare enrollment for 2012?  Has anybody
>on regular Medicare signing up for a Medicare supplement found a plan that
>covers CGM?  As far as I can tell, regular Part B Medicare will not cover CGM
>and therefore no Medigap or supplemental plan will provide coverage.  I am
hoping that there is somebody out there that will prove me wrong.

>  .  .  .


Jerry,

You asked whether anyone knows of a Medicare Supplement or Medigap 
policy that covers CGM supplies.  I have such a plan (and have 
written about it to the Yahoo CGMS mail list and to this list).  Here 
is an updated summary of messages I posted in April 2009 and Sept. 
2011.

When I took retirement at age 65 in 1995 and went on Medicare B, I 
signed up for a Medicare-supplement group policy through my former 
employer.  This insurance is administered by United Healthcare and 
pays 80% of the 20% not covered by Medicare; UHC's payment is 
strictly based on the Medicare-approved amounts. 

My plan also includes prescription-drug coverage through Medco 
Health, either by mail order or by purchase in local participating 
drugstore.  Medco sent me a special card to use in local drugstores. 

As we know well, Medicare does not normally pay for a CGM or sensors. 
So I understood from the start that I would have to pay for the CGM 
system and the sensors out of my own pocket, and did so at full price 
when I started using the Minimed Real-Time CGM in Sept. 2007.  In 
April 2009, while I was placing a sensor order, the Medtronics agent 
asked me for the numbers on that Medco Health card I use in local 
drugstores.  When he ran these through his computer, my cost for a 
box of 10 sensors turned out to be about $210 instead of the $350 I 
had been paying in the past.  Not long afterward (I don't remember 
when) my cost dropped even further to about $108, a 69% discount.  In 
late 2010 Medtronics raised the list price for a box of 10 sensors to 
$420; since then I have been charged about $130 per box, still a 69% 
discount.

I don't know whether my Medco plan is part of the UHC coverage or is 
an add-on provided by my former employer; I am not billed separately 
for the Medco plan.  Neither do I know if individuals can purchase 
this coverage.  [If you send me a private email, I will furnish you 
the plan numbers for both coverages should you want to ask UHC or 
Medco about this specific insurance.]

Finally, I should mention that this Medicare-supplement coverage is 
not cheap.  In 1995 it cost only $50/month for my wife and me, but 
the cost went up substantially over the years.  Currently $320 is 
deducted from my pension each month to pay for it; my employer's 
retirement fund pays an equal amount.  This amounts to $3840/year for 
each payer!

Mel Halbert
.
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