Musings on Approaching Medicare

Sue_HeadSquare2I will turn 65 in May, which means I will be Medicare eligible. I have several friends and family members who thought going on Medicare was a wonderful blessing, because they now had affordable health insurance that also covered extras like well exams and gym memberships. Of course I think that Medicare is a blessing for seniors. However, for Type 1 diabetics who have had use of a continuous glucose monitor (CGM) to give them a continuous readout of their blood sugars, thus minimizing hypo and hyperglycemic episodes, this often meant that they lost whatever health insurance plan they were on, and were forced to go on Medicare. Unfortunately, Medicare presently does not cover CGM’s because they consider it “precautionary equipment”.

Anyone who regularly reads Test Guess and Go and has read Sue from Pennsylvania’s blogs about her husband losing his CGM coverage and his numerous appeals to get it reinstated already knows what a futile effort that is. Thankfully, Sue’s husband was able to get CGM coverage through the Veterans Administration. There is presently a House bill (H.R. 5644: Medicare CGM Access Act of 2014) and a companion Senate bill (S. 2689) that would facilitate Medicare coverage of CGM’s. If you haven’t already done so, please ask your representative and senator to co-sponsor these important bills.

I am somewhat apprehensive as I approach Medicare. I say somewhat, because I am lucky to have retiree health insurance through the school district I worked for, and will be able to continue with this insurance after I go on Medicare. I presently have excellent coverage of my CGM, but at one time I received a denial of coverage, appealed the decision and won my appeal. I am concerned that my insurance plan will follow Medicare guidelines and deny coverage. I will not know until I go on Medicare, so I will have to wait and see what happens, but I am hoping that they will continue to cover my Dexcom CGM. I am continually thankful that I have it, and am amazed at how much my quality of life has improved despite sometimes annoying beeps that warn me of impending high and low blood sugars.

I have been using the Omnipod pump since 2007, my one and only pump. I know that Medicare does not cover this pump, so if my retiree insurance won’t continue to cover this pump I will be forced to use a tubed pump. This is not such a big deal to me as continuing to use the Dexcom.Medicare Questions

If I am unlucky and my insurance plan won’t continue to cover my Dexcom, I will join the hundreds of other senior Type 1’s who can’t benefit from CGM coverage, putting their lives  in danger every day. I pray that we can get more momentum for these bills and get them both signed into law.

If you have not previously contacted your Senators and U.S.
Representative to support CGM Coverage by Medicare, please
click here to go to the JDRF page that contains links and
easy-to-follow instructions to have your voice heard.

6 thoughts on “Musings on Approaching Medicare

  1. Sue, I look forward to hearing about your experiences as you get closer to Medicare. I will be at that point two years after you and am already concerned about the changes that it will mean for my health management. You are lucky to have the retiree plan because at least that gives you a fighting chance to get CGM coverage. Fingers crossed for you:-)

    • Thanks Laddie. I hope that by the time you reach Medicare, the bills are passed and Medicare will cover the CGM.

  2. I am already on Medicare and its a nightmare/ I have being using a Medtronic pump for over 22 years.I current use the 530g with enlite sensors. I have been using the CGM for over 4 years. I have been T1D for over 44 years. I became Medicare eligible in December of 2012. At first Medicare denied all pump and CGM related DME. Everything has been going through the Medicare appeal process. I use a pump wsith tubing and Medicare currently does not cover any pump that is considered part of a system, hence they are not covedring any pump that would work with a CGM because they consider it a system.I have had 2 ALJ hearing with Medicare. One for sensors was ruled unfavorable (denied). I just got that notice and have 60 days to decide if I want to go further. I have not heard on the other one yet. Just recedntly, I received a letter from Medtronic and they are saying that Medicare will now group the CGM as part of the pump and hence, pay the pump and supplies but include the sensors in that cost. Henced, Medicare will not be denying the CGM and then secondary insurance will only pay 20%. Additionally, Medtronic will most likely stop supplying Medicare patients because they would incur a huge financial loss. Please feel free to contact me. My email is Also the House and Senate bills are currently buried in Committee and not moving anywhere! Thanks, Sue from Long Island, NY

  3. Great blog and thanks for mentioning us. Here’s hoping that you won’t have any problems once you go on Medicare. Marc was so lucky to have the VA but my heart aches for all those who are suffering because they don’t have a CGM. And I will always continue to hope that the Senate and Congressional bills keep gaining co-sponsors and that the JDRF Petition keeps getting more signatures. I see the glass as half full and each and every day I get updates from GovTrack with new names of those who have signed on to co-sponsor the bills.

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