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Making Sense of Medicare, CGMs, and Why It Matters

by Kerri Sparling

Twitter summary: Why #MedicareCoverCGM is critical – support coverage & reimbursement of CGMs for the elderly

Short summary: Medicare does not cover CGM for those over 65, and this means that many people successfully using CGM are suddenly taken off this life-enhancing technology. The issue is especially critical because elderly patients are at the highest risk for severe hypoglycemia, and CGM can help avoid these events. Why we can’t let this happen and what you can do about it – sign a petition and send letters to your congressional representatives to advocate for Medicare CGM coverage.

I’ve used a Dexcom CGM (from the three-day STS system to the G4 Platinum) since 2006, and the positive influence it has had on my diabetes management and overall quality of life is undeniable. During my pregnancy, my CGM helped protect me from the intense and often symptom-free lows of the first trimester. When I travel on my own, my CGM is the safety net on my bedside table, ready to alarm should my blood sugar go out of range while I’m sleeping. But as it stands now, Medicare will not cover CGM for anyone.

Why should I care that Medicare doesn’t cover continuous glucose monitoring?

Whether you are a senior with diabetes, a new adult with diabetes, or the parent of a child with diabetes, this issue matters because diabetes doesn’t disappear at age 65. If your goal is to live a long and healthy life, this issue matters because it helps ensure your safety and wellbeing as you age.

Why are CGMs important?

Lynn Wickwire, Consumer Advocate at the Joslin Diabetes Center and a Joslin 50 Year Medalist, was diagnosed with type 1 at the age of four-and-a-half and will mark his 70th year with the disease in the coming months. As he says, “I have been on a CGM for probably ten years, dating from the first time Abbott came out with their trials for the Navigator. Prior to going on the Navigator, my wife was having to give me glucagon almost once a month or every other month because of [hypoglycemia] events when I was unconscious or unable to function. My quality of life - and my wife's and children’s - improved immeasurably because of the CGM. There was no longer the worry that I would end up in the hospital because of an accident or worse. Since going on the CGM, my wife has not had to give me glucagon once because of a low blood glucose.”

Low blood sugars can be crippling and terrifying in both their immediacy and lasting impact, with the threat multiplied if you experience hypoglycemia unawareness. Even the best, tightest, and most well-controlled diabetes still comes with the threat of lows or highs. This is why CGMs are important for people with diabetes because they provide a crucial and much-appreciated safety net for people with diabetes and their families. 

If I’m not on Medicare, how does this affect me?

What good is a CGM if you can’t afford it? Technology is amazing and life-saving, but it’s expensive, and the cost can be highly prohibitive for patients. In order for patients to be able to get their hands on a CGM, insurance companies need to start reimbursing for it. The trouble is, the Centers for Medicaid & Medicare Services (CMS) will not pay for CGMs. This is a problem because even if you aren’t on Medicare, private insurance companies often look to Medicare to determine what is, and isn’t, medically necessary. 

So what’s the trickle-down, in terms of the artificial pancreas? If CMS won’t cover a CGM, it definitely won’t cover a CGM/pump closed loop system. If CMS covers a CGM, that helps pave the way for coverage for upcoming artificial pancreas systems.

What can I do right this second?

The JDRF has taken the lead on creating a petition and it takes all of 30 seconds to sign (maybe a full minute if you go the extra mile of sharing it with your circles). The petition is titled “Tell Medicare to Cover Continuous Glucose Monitors for People with Diabetes” and by signing, you are adding your voice to the thousands of people who think this issue is important.

Also, you can share your personal story as to how and why continuous glucose monitoring is important to your diabetes care. I know it can sound self-serving, but real stories from real people matter when it comes to making issues personal.  You can use the #MedicareCoverCGM hashtag to help thread these stories through social media like Facebook and Twitter

Diabetes will be part of my life when I turn 80, but by investing in my future now, my good health and independence can be as lifelong as diabetes. It’s not a matter of wanting the newest and shiniest diabetes toy; it’s about staying as healthy I can for as long as I can.

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