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FreeStyle Libre Medicare Coverage

FreeStyle Libre is a continuous glucose monitor (CGM) that consists of a small, water-proof, fully disposable sensor that you wear on your arm for 14 days, plus a reader device.

The reader shows your blood glucose levels in real time, and it doesn’t require a finger stick like most CGMs do. FreeStyle Libre is approved for monitoring blood glucose levels in both Type 1 and Type 2 diabetics.

FreeStyle Libre Medicare coverage is much like other Medicare coverage for durable medical equipment (DME). You may have to pay coinsurance or copays, and you have to purchase your DME from a Medicare-approved supplier.

How does FreeStyle Libre Medicare Part B coverage work?

Patient at Doctor's Appointment - Medicare Plan Finder

Medicare Part B is medical insurance, and it helps pay for outpatient doctor’s appointments, preventive care such as diabetes screenings, and durable medical equipment (DME). In order for Medicare to approve your DME, your doctor must prescribe it, and it must be a device that will last for three years or more.

You may be responsible for 20 percent of approved Medicare costs for FreeStyle Libre including the equipment itself and your doctor’s supervision.

Medicare Supplement Coverage for FreeStyle Libre

Medicare Supplements (Medigap) plans are private insurance plans that can help pay for expenses that you may incur with Original Medicare (Part A and Part B) such as coinsurance and copays. They work like this: you pay a monthly premium, and your copays and coinsurance, including what you’d pay for durable medical equipment, are covered. 

Medicare Advantage FreeStyle Libre Coverage

Medicare Advantage (MA or Part C) plans are also private plans. They work differently than Medigap plans because MA plans offer additional benefits rather than help paying for financial items. 

You cannot have both a Medigap plan and a Part C plan, so it’s best to contact your agent to discuss your individual needs, including coverage for diabetes and durable medical equipment.

Contact Us | Medicare Plan Finder

How much does FreeStyle Libre cost without insurance?

According to GoodRx, FreeStyle Libre can cost about $135 every two weeks. That adds up to $3,510 per year.

Medicare Coverage for Insulin

Original Medicare does not help cover insulin unless it’s in conjunction with an insulin pump. Medicare Part D or certain Medicare Advantage plans may help cover insulin products such as Lantus and Novolin.

According to GoodRx, Lantus is the most popular insulin drug. The average copay is $37.50-$67.50. 

Rx Discount Card | Medicare Plan Finder

Where can I get FreeStyle Libre?

You can get FreeStyle Libre at most major pharmacies, however, Medicare may only cover the device if you get it at a “participating DME supplier.” According to Abbot, the FreeStyle Libre manufacturer, Medicare will help pay for the device if you purchase it from one of the following suppliers: 

  • Advanced Diabetes Supply
  • Better Living Now 
  • Byram Healthcare 
  • CCS Medical 
  • Diabetes Management & Supplies 
  • Edgepark Medical Supplies 
  • Edwards Health Care Services 
  • HealthLink Solara Medical Supplies 
  • J&B Medical Supply 
  • Mini Pharmacy 
  • United States Medical Supply 

In order for Medicare to cover your durable medical equipment, your doctor must say it’s medically necessary. You may need to have periodic follow-up appointments in order for Medicare to continue covering FreeStyle Libre.

How do I use a FreeSyle Libre system?

With the FreeStyle Libre 14-day system, you’ll wear a small sensor on the back of your upper arm that automatically* monitors your glucose 24 hours a day.

Instead of finger pricks**, you simply swipe the reader over the sensor on your arm for a painless, one-second scan. Each scan provides an up-to-the-minute glucose reading, a graph to spot trends, and an eight-hour history of your glucose levels.

*The FreeStyle Libre system requires a one-hour warmup period when you first wear the device before you can check your blood glucose levels.

**You may still have to prick your fingers in certain situations including when your symptoms don’t match your CGM readings and when you suspect that the readings may not be accurate.

Difference Between FreeStyle Libre and Other Constant Glucose Monitors

According to the Diatribe Foundation, a company that distributes information about diabetes, another CGM called the Dexcom G6 received Medicare DME approval in early 2019

Like Abbot’s FreesStyle Libre, Dexcom’s G6 is covered for people on “intensive insulin therapy like multiple daily injections or use of an insulin pump.” 

Both devices feature a smartphone app that you can use to closely monitor your blood glucose and manage your insulin treatment. According to Diatribe, Medicare covers CGM smartphone apps “including sharing features.”

The main differences between FreeStyle Libre and G6 are the “warmup periods” and how long you can wear the devices. FreeStyle Libre features a one-hour warmup period, and you can wear the device for two weeks. The Dexcom G6’s warmup period is two hours, and you can  wear the device for 10 days.

Who needs constant glucose monitoring?

Couple Learning About Glucose Monitoring on Tablet - Medicare Plan Finder

Diabetic people need constant glucose monitoring because their bodies can’t produce insulin or efficiently use the insulin it makes. Insulin is a hormone that regulates blood sugar levels. 

FreeStyle Libre is best for diabetics who use insulin pumps or need multiple insulin injections per day. According to the Mayo Clinic, if you don’t manage diabetes, it may lead to the following complications

Along with managing blood glucose levels, a balanced diet such as the Mediterranean diet, exercising regularly, and maintaining a healthy weight may help prevent type 2 diabetes or manage type 1 diabetes symptoms and complications. Work with your doctor to develop a comprehensive treatment plan.

Click to read more about diabetes.

Find FreeStyle Libre Medicare Coverage

If you have diabetes and you want to learn more about Medicare coverage for FreeStyle Libre, a licensed agent with Medicare Plan Finder can help.

Our agents are highly trained, and they may be able to find plans in your area that cover fitness programs, meal delivery, hearing, and/or routine vision care. To set up a no-cost, no-obligation appointment to discuss your needs, call 1-844-431-1832 or contact us here now.

Home Health Tests Seniors Should Try

We’re all aware we should make an effort to regularly see our physicians. But we also know that life tends to get in the way. 

Especially for seniors, transportation and cost can often prevent routine doctor visits. However, just because you can’t get to your doctor’s office, doesn’t mean you have to stay in the dark about your health. There are quite a number of tests that you can perform without ever leaving home!

Tests You Can Do At Home Today

The range of at-home tests and testing methods varies widely. Some require expensive medical equipment only available through a supplier and with a prescription, while others require only a pen and paper. Here are some tests that you can do today with little to no supplies

SAGE Test for Dementia

The Self-Administered Gerocognitive Exam, or SAGE, was devised by researchers from the Wexner Medical Center at Ohio State University. SAGE can help detect early warning signs of cognitive impairment and memory loss in less than 15 minutes.

The test has several components and several forms, all of which can be viewed and downloaded at the Wexner Medical Center’s website. These include sections on orientation, language, memory and visuospatial awareness.

The most well-known element of the SAGE is known as the clock drawing test. All you need to do is get out a pen and paper and draw a picture of a clock, with the hands reading 3:40. Then compare your drawing to a real clock to see how you scored.

If your circle is closed, give yourself a point. If all twelve numbers are accounted for and in the right place, you get two more points. If your hands are in the correct position as well, you passed with flying colors. A score of any less than three points, however, might be an indication that you should see your physician for further screening. This test is sometimes performed without the rest of the exam, though it is usually recommended to perform the entire SAGE test for dementia detection.

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Window Test for Vision Loss

Our eyes take a lot of abuse these days from the onslaught of screens and artificial lighting. It’s even more severe as we get older and the natural, age-related loss of vision begins to take effect. If you experience some trouble reading, give yourself this informal at-home eye exam to judge whether or not you should seek an eye care professional.

First, sit across the room from a large window or door so that you can see all the lines of the frame around it. Cover one eye and focus on the window or door frame with your open one for 30 seconds. Then repeat with the opposite eye. The horizontal and vertical lines of the frame should be clearly visible with no missing or hazy areas. If the edges of the frame seem distorted or warped, this may indicate macular degeneration, a disease that is currently the leading cause of irreversible vision loss in people over 60.

Cushion Test for Peripheral Arterial Disease

The cushion test can be performed without even getting out of bed! It can help detect blocked arteries in your legs and feet, a condition known as PAD, or peripheral arterial disease. Those with high blood pressure or diabetes, both common among seniors, are especially at-risk for this disease. 

To perform this test, lie on a bed and elevate your legs with pillows or cushions until they are resting at a comfortable 45-degree angle. Keep them there for one minute, then sit up and swing your legs over the side of the bed so that they hang at an angle of 90 degrees. If either or both of your legs turn pale when elevated and take several minutes to return to their normal shade after sitting up, you may need to consult your physician with the results from this peripheral artery disease test.

Phalen’s Maneuver for Carpal Tunnel

We are an increasingly computer-savvy society and people of all ages are typing more than they used to. Extended periods of typing are strongly associated with carpal tunnel syndrome, a painful condition caused by a pinched median nerve in the wrist, but many other activities like driving can bring on these symptoms as well. Furthermore, people over 55 years old are at a much higher risk and those over 65 are more likely to have cases that are severe.

Phalen’s maneuver is a test devised to diagnose carpal tunnel at home and has been shown to be surprisingly effective. To see for yourself, press the tops of your hands together with your fingers pointing toward the floor and your elbows extended. If you can, hold this position for a full minute. If you feel an unpleasant sensation, such as prickling, tingling, or burning, you may likely have carpal tunnel and should consider preventive measures.

Check out this video from Physiotutors on YouTube that explains how to perform the Phalen test:

Testing With Medical Equipment

Some at-home health tests will require special instruments to fully gauge the results. While many of these items can be freely obtained from online and brick-and-mortar retailers, some require ordering through a medical supplier with a doctor’s prescription. Below, we will detail some of the testing you can do at home with the help of specially-designed medical equipment.

Blood Sugar Test

For the 12 million seniors living with diabetes* (about 25% of those over the age of 65), monitoring blood sugar levels is an near-constant concern. Luckily, this is something that can be checked at home or on-the-go using a blood glucose monitor, or glucometer. These can be found online or in pharmacies in the form of kits, which include testing strips, needles (called lancets), and the glucometer itself. 

Read about Medicare coverage for Diabetes!

To test blood sugar at home, you will need to insert a test strip into the electronic monitor and prick the side of your finger with the provided lancet. Gently apply pressure to that finger until you see a drop of blood form, then touch it to the edge of the test strip. In just a few seconds, you will have an accurate metering of your current blood sugar levels, no matter where you are.

Blood Pressure Test

Along with heart rate, breathing rate, and body temperature, blood pressure is one of the four most significant vital signs that our bodies produce. High blood pressure can be caused by countless factors like high cholesterol, stress, and even fear, and affects almost 70% of adults between the ages of 65 to 74. Monitoring blood pressure accurately is vitally important, as symptoms may not manifest until these levels are dangerously high. Doctors maintain accuracy by using large, costly machines but there are ways to test blood pressure at home with minimal equipment.

The quickest and most accurate results will come from automated, electronic blood pressure monitors that come with an upper arm cuff. Many different brands of at-home blood pressure cuff exist and can be found at pharmacies or similar retailers. The directions for use may change from model to model but there are certain rules that apply no matter what brand you use, including placing the cuff directly on the skin, placing the feet flat on the floor, elevating the arm to chest height, and avoiding smoking or drinking for 30 minutes before testing.

At-Home Lab Tests

Another popular method of in-home health testing comes in the form of test kits that can be ordered right to your door. These vary widely, not only in terms of what is being tested, but also in the method of sample collection. Some services will send a team of professionals to administer and retrieve your test, while others will only send instructions and require you to send your samples back in the mail for results. These can be purchased to test for a wide range of conditions, including food sensitivity, hormone testing, DNA testing, and other at-home blood tests.

Medicare DME Coverage

Medical equipment may be needed for certain tests.

Durable medical equipment, or DME, is a designation that Medicare uses to classify coverable medical equipment that can be used in the home. This benefit might be used to cover the cost of equipment to aid in the at-home testing we have already covered. The covered equipment can range from crutches and canes to CPAP devices and hospital beds, though it all must come from a Medicare-approved medical supplier.

Medicare-Approved Glucose Meters

Blood sugar monitors and test strips are usually covered under Medicare Part B as durable medical equipment for home use with a doctor’s prescription. You may be able to rent or buy a glucometer but Medicare will only provide coverage if both your physician and the supplier are both enrolled and participating in Medicare. Be sure to clarify this with your doctor and equipment supplier, as some may be enrolled but not “participating” and may not accept the cost of assignment.

Read more about durable medical equipment Medicare coverage.

Does Medicare Cover Blood Pressure Monitor?

Medicare Part B may cover the cost of a blood pressure monitor or ambulatory blood pressure monitoring (ABPM) device but only under very specific circumstances. Part B will cover a blood pressure monitor and stethoscope for those who receive blood dialysis treatment in their home and will pay for the rental of an ABPM device for patients who have exhibited “white coat hypertension,” a phenomenon where nervousness in clinical settings causes artificially high blood pressure readings. 

For those with Medicare Part C, or Medicare Advantage, all the benefits of Parts A & B will be covered but may also include additional benefits and expanded coverage. Contact your insurance company to find out if your Part C plan covers blood pressure monitors or glucometers.

If you don’t have a Medicare Advantage plan, give us a call at 844-431-1832 or contact us online to speak with a licensed agent and find a plan that can address your healthcare needs!

A Guide to Medicare Insulin Coverage

According to the Kaiser Family Foundation (KFF), a non profit healthcare organization, Medicare Part D (prescription drug) spending increased from $1.4 billion to $13.3 billion from 2007 to 2017. 

The huge increase in drug costs ultimately gets passed to the consumer. KFF also said that insulin out-of-pocket costs have “quadrupled.” That may be the case, but Medicare insulin coverage may help lower costs if you qualify.

How Does Medicare Insulin Coverage Work?

Nurse Administering Insulin - Medicare Plan Finder

Original Medicare is the public health insurance that helps beneficiaries pay for medical expenses. It does not cover prescription drugs, with one exception — insulin.

However, Medicare insulin coverage is limited. Medicare Part B (medical insurance) only covers insulin if it’s administered with an insulin pump. The pump is considered to be durable medical equipment (DME), which Medicare helps cover when medically necessary.

That means that while Original Medicare may help pay for insulin pumps, diabetes screening/treatment, and even orthotics for diabetics, Original Medicare does not cover insulin by itself.

If you’re eligible for Medicare and want insulin coverage, you have two options. One option is through a Medicare Part D plan that only helps cover drugs. The other option is through a private insurance plan called a Medicare Advantage Prescription Drug (MAPD) plan. 

Many Part D and MAPD plans use a formulary to determine how much you pay at the pharmacy. A formulary is a list of the drugs your plan covers. The list divides prescriptions into tiers. Each tier has a different copay or coinsurance amount. According to GoodRx, Lantus, the most popular insulin has “a copay of $37.50-$67.50.” That’s a significant savings when you consider that the estimated Walmart pharmacy retail price is $507.

Free Prescription Discount Card

How Can I Get Insulin at a Lower Price?

If you have a limited income, you may be able to receive help for Part D premiums and drug costs with a Low Income Subsidy (LIS), also called Extra Help. LIS eligibility is based on your income, assets, and the Federal Poverty Level. According to the Social Security Administration (SSA), Extra Help can save you almost $5 thousand per year. If you’re eligible for LIS, you won’t pay more than $8.50 for covered name brand drugs or $3.40 for covered generic prescription drugs. 

If you qualify for LIS, you may also qualify for Medicaid. If you qualify for both Medicare and Medicaid, you may qualify for a Medicare Advantage plan called a Dual Special Needs Plan (DSNP). Many DSNPs offer prescription drug coverage with low copays. DSNPs may also offer additional benefits such as fitness classes, vision coverage, and meal delivery.

If you have LIS or a DSNP, you are eligible for a Special Enrollment Period (SEP), which allows you to enroll in new coverage or change existing plans at different parts of the year. 

Many people have to wait until the Annual Enrollment Period (AEP), which is from October 15 to December 7 to make changes. With a LIS or DSNP SEP,  you can make one change per quarter from January to September. Those changes will take effect on the first of the month following your change. You can make changes during AEP as well, however, those changes won’t take effect until January 1 the following year.

SEPs can be long-term or temporary. For example, in the case of a DSNP, you have a SEP for as long as you qualify for both Medicare and Medicaid. If you gain or lose Medicaid coverage, you have a temporary SEP, which allows you 30 days to enroll in a new plan. 

To illustrate how a DSNP SEP works, let’s take the hypothetical example of a 70-year-old man who’s recently qualified for Medicaid. In this example, it’s January 12 and the man qualified on the 10th. The man has until February 9 to enroll in a DSNP. Let’s say he enrolls on February 9. The new coverage will take effect on March 1.

If the man decides he’s not satisfied with his new plan, he can make one change on April 1, which is the start of the second quarter of the year. The man won’t be allowed to make any more changes until July 1. He won’t be allowed to make any changes after September 30 with his DSNP SEP.

Why Is Insulin So Expensive?

According to NPR, many different factors affect insulin’s price. The most important factor is that there’s no generic equivalent to insulin. 

With many drugs, other manufacturers cannot legally create generic versions because of patent laws

Once a patent expires, manufacturers have license to create generic versions of brand-name drugs. Generic drugs are often much cheaper than their name brand counterparts. According to the World Health Organization, current insulin patents won’t expire until 2030.

What Is Insulin?

Insulin is a hormone produced in the pancreas that regulates blood sugar. Your body will store glucose in your liver if there’s more sugar than it needs. Insulin will trigger your body to release that sugar when you need it. 

If your blood sugar is too high, you can develop diabetes, which is when your body can’t use insulin efficiently or make its own insulin. Type 1 diabetes is when the pancreas can’t make insulin. Type 2 diabetes  is when the pancreas makes insulin, but the body doesn’t respond well to it. 

The drug insulin dates back to the early 1920s. Researchers conducted a clinical trial with diabetes patients. The trial used insulin from cattle pancreases, and “most patients recovered.” After the trial, insulin was “produced and sold on a massive scale around the world.” Both type 1 and type 2 diabetes need insulin shots to use glucose from food.

Types of Insulin

Pharmacist Explaining Insulin - Medicare Plan Finder

According to the American Diabetes Association, there are different types of insulin. The type of insulin your doctor prescribes depends on how quickly it works and how long it lasts. Insulin may have a peak blood-sugar lowering capacity and length of total time it works. Injectable insulin is the most common, and it can be divided into five types:

  1. Rapid-acting insulin: Starts to work about 15 minutes after injection, peaks in about one hour, and continues to work for two to four hours. 
  2. Regular or short-acting insulin: Typically reaches the bloodstream within half an hour of injection, peaks anywhere from two to three hours after injection, and is effective for approximately three to six hours.
  3. Intermediate-acting insulin: Usually reaches the bloodstream about two to four hours after injection, peaks four to 12 hours later, and is effective for about 12 to 18 hours.
  4. Long-acting insulin: Reaches the bloodstream several hours after injection and can lower glucose levels for 24 hours or longer.
  5. Ultra long-acting insulin: Reaches the bloodstream in six hours, does not peak, and lasts about 36 hours.

Another way to take insulin is inhaled insulin. According to the American Diabetes Association, it begins working in 12-15 minutes, peaks by about 30 minutes, and leaves the body in about three hours.

No matter what type of insulin your doctor prescribes, be sure to follow the instructions for taking and storing the insulin. For example, all insulin comes in liquid form. You may have to refrigerate insulin so it doesn’t expire too soon.

Get Medicare Coverage for Insulin

If you need insulin coverage, a licensed agent with Medicare Plan Finder may be able to help. Our agents are highly trained. They can find what Part D and/or Medicare Advantage plans are in your area, and they can even help you apply for LIS. To set up a no-cost, no-obligation appointment call 844-431-1832 or contact us here today.

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