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.
> . . .
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.
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%
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
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