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Does Medicare Cover Insulin Pump For Type 2 Diabetes

Type 2 Diabetes: What Is It

Type 2 Diabetes: What Is It

Find Affordable Medicare Plans in Your Area The National Institutes of Health (NIH) defines diabetes as a condition where your body doesnt make enough of the hormone insulin, or doesnt use insulin properly. Insulin is a hormone produced by the pancreas that helps control the amount of blood sugar, or glucose, in the blood and helps it get to cells to give you energy. Type 2 diabetes is one of the most common forms of the disease, according to the Centers for Disease Control and Prevention. More than 29 million people in the United States have diabetes, according to a 2016 report by the National Institutes of Health. Thats about 9.3% of the population. Over a quarter of Americans aged 65 and over have diabetes. And about 95% of adults with this disease have type 2 diabetes. What are commontype 2 diabetessymptoms? Unlike type 1 diabetes, which often develops during childhood or young adulthood, the symptoms oftype 2 diabetesusually develop during middle age or later. According to the National Institutes of Health (NIH),type 2 diabetessymptomsinclude: Sores that wont heal, or are very slow to heal Keep in mind that not everyone experiences all of these symptoms; some people may have different signs of the disease. And some people dont notice any symptoms at all, according to the NIH publication Medline Plus. What are some possible complications oftype 2 diabetes? Untreated or uncontrolled diabetes can lead to complications with many of your bodys organs, such as your kidneys, eyes, and heart, according to the NIH publication Medline Plus. The NIH reports that people withtype 2 diabetesmay be at a higher risk (compared with those who dont have the disease) for: Damage to the eyes (diabetic retinopathy) including possible blindness Nerve damage in the feet and legs, which m Continue reading >>

Decision Memo For Insulin Pump: C-peptide Levels As A Criterion For Use (cag-00092r)

Decision Memo For Insulin Pump: C-peptide Levels As A Criterion For Use (cag-00092r)

To: Administrative File CAG-00092R Insulin Pump: C-Peptide Levels as a Criterion for Use From: Steve Phurrough, MD, MPA Director, Coverage and Analysis Group Marcel Salive, MD, MPH Director, Division of Medical and Surgical Services Coverage and Analysis Group Elizabeth Koller, MD Medical Officer, Division of Items and Devices Coverage and Analysis Group Lawrence Schott, MD, MS Medical Officer, Division of Medical and Surgical Services Coverage and Analysis Group CDR Betty Shaw, USPHS Health Insurance Specialist, Division of Medical and Surgical Services Coverage and Analysis Group Elizabeth Truong Health Insurance Specialist, Division of Medical and Surgical Services Coverage and Analysis Group Subject: Coverage Decision Memorandum for C-Peptide Levels as a Criterion for Use of Insulin Pumps Date: December 17, 2004 CMS has determined that the evidence is adequate to conclude that continuous subcutaneous insulin infusion (CSII) is reasonable and necessary for treatment of diabetic patients: 1) who either meet the updated fasting C-peptide testing requirement or are beta cell autoantibody positive; and 2) who satisfy the remaining criteria for insulin pump therapy detailed in the Medicare National Coverage Determinations Manual (Medicare NCD Manual 280.14, Section A.5). CMS has determined that fasting C-peptide levels will only be considered valid when a concurrently obtained fasting glucose is ≤ 225 mg/dL. Insulinopenia is defined as a fasting C-peptide level that is less than or equal to 110 percent of the lower limit of normal of the laboratory’s measurement method. Alternatively, for patients with renal insufficiency and a creatinine clearance (actual or calculated from age, gender, weight and serum creatinine) ≤ 50 ml/minute, insulinopenia is defined as a fast Continue reading >>

Medtronic Is ‘only Game In Town’ For Insulin Pumps

Medtronic Is ‘only Game In Town’ For Insulin Pumps

What is an insulin pump? An insulin pump is a small machine worn on the body for many hours at a time that can give small doses of insulin for patients whose bodies don’t make enough of the hormone naturally. Pumps cost between $4,000 and $8,000 apiece. Since they often come with a four-year warranty, insurance companies typically will only pay for one pump every four years. < Medtronic’s MiniMed 670G Using an insulin pump is an act of profound trust. Diabetic patients wear their insulin pumps at virtually all hours, relying on the medical machinery to administer doses of a potentially lethal hormone to keep their blood-sugar levels from going dangerously out of range. So it came as a shock to Ed Komp when he learned last month that his pump maker, Johnson & Johnson (JNJ), was halting all North American sales of its Animas brand insulin pumps and pushing its customers toward devices and supplies made by Medtronic. Komp had dropped Medtronic a decade ago, choosing Animas pumps instead. Now he must reconsider his options after getting the Oct. 10 letter from JNJ. “My first response was really one of fear,” said Komp, a software engineer at the University of Kansas who has used insulin pumps to treat his Type 1 diabetes for 25 years. “I’ve made the change once, and it’s a really hard change, actually. Very small differences have a big impact for me personally.” Minnesota-run Medtronic has emerged as a major winner in the $1.7 billion U.S. market for insulin pumps and supplies, as thousands of letters limiting patient choice have been sent out to diabetics, from both manufacturers and insurers. Insulin pumps typically sell for between $4,000 and $8,000 and deliver small, frequent doses of insulin day and night, which typically benefits Type 1 diabetics, whos Continue reading >>

Aade: Medicare Isn't Providing Diabetes Supplies Like It Should

Aade: Medicare Isn't Providing Diabetes Supplies Like It Should

Seems like there's always some new roadblock cropping up to thwart us from getting the diabetes supplies we need… The latest hurdle comes from the beleaguered Centers for Medicare & Medicaid Services (CMS). According to a new survey just released by the American Association of Diabetes Educators (AADE) on Feb. 3 -- surprise, surprise! -- CMS is now limiting patient access to insulin pumps as well as meters, strips and other basic supplies. The results are disturbing, and they add to the already dismal state of affairs at as it pertains to diabetes. Remember that CMS introduced its controversial competitive-bidding process in 2013, requiring PWDs (people with diabetes) on Medicare to choose from an approved short-list of diabetes suppliers to get what they need to survive. First, this limited only glucose meters and strips by mail-order. And then the limits expanded to pharmacies. We were worried, but were reassured by the government and CMS leaders that all would be OK. Yet an initial AADE survey from early 2014 found that the competitive-bidding process was failing PWDs on Medicare who needed mail-order testing supplies. Because CMS is not properly monitoring the companies selected for the bidding process and “the agency has not taken action against suppliers who have changed their offerings since their bids were accepted,” they are getting away with offering customers the cheapest, lowest-quality glucose meters, according to testimony from AADE Chief Advocacy Officer Martha Rinker in the 2014 survey. CMS recently announced inclusion of insulin pumps on the list of medical supplies going through competitive-bidding in nine regions across the country. For the AADE survey conducted last Fall, educators across the country called up a total of 29 different supplies l Continue reading >>

Medicare Coverage To Treat Diabetes

Medicare Coverage To Treat Diabetes

Diabetes is a common medical condition in which the body either doesnt make enough insulin or doesnt respond properly to the insulin it makes. A healthy body uses insulin to process sugars, but when there isnt enough insulin in the body, too much sugar stays in your blood. If your blood sugar remains consistently high, your doctor may diagnose you with diabetes. The information contained in this article is for informational purposes only. It should never be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition. Medicare Part BandMedicare Part Dgenerally cover the services and supplies needed to control diabetes. Heres a breakdown of how Medicare covers diabetes. Medicare Part B covers the fasting blood glucose test, which is a diabetes screening. Medicare covers two diabetes screenings each year for beneficiaries who are at high risk for diabetes. High risk factors for diabetes include: high blood pressure, history of abnormal cholesterol and triglyceride levels, obesity, or a history of high blood sugar. If diabetes runs in your family, you may also need regular diabetes testing. Your doctor may also recommend services that Medicare doesnt cover. You generally pay nothing for these diabetes tests if your doctor accepts the amount approved by Medicare for the diabetes screening. However, you may have to pay 20% of the amount approved by Medicare for the doctors visit. If your doctor diagnoses you with diabetes, Medicare covers the supplies you need to control your diabetes, including blood sugar testing monitors, blood sugar test strips, lancet devices and lancets, and blood sugar control solutions. Medicare Part B may cover an external insulin pump and insulin Continue reading >>

Making The Switch To Medicare With Diabetes

Making The Switch To Medicare With Diabetes

By Pearl Subramanian and Jeemin Kwon From enrolling in the four types of plans to what they cover, everything you need to know when making the switch to Medicare with diabetes Despite covering 58 million Americans in 2017, Medicare can be difficult to navigate. The US-government-run program provides health coverage to people over the age of 65 and to those under 65 who have certain disabilities or other conditions. If you are ready to make the switch over to Medicare or know someone who is, this article is a guide on what you need to know for as smooth a transition as possible, understanding that there are plenty of complexities here! Click to jump to a section: About Medicare Though Medicare is often thought of as one big plan, it actually has four different types of coverage: Part A covers hospital stays, care in nursing facilities, hospice care, and home health care. Part B covers doctors’ services, non-hospital (outpatient) care, some medical devices and preventative services. People pay a monthly premium for this coverage. Part C allows people the option to enroll in private insurance plans (HMOs and PPOs) and to receive their benefits under Parts A and B. Those plans are called Medicare Advantage and some offer additional benefits such as dental and vision. Part D covers prescription drugs and is voluntary. For more information on decoding and understanding health insurance language, check out diaTribe’s guide here. Medicare and Diabetes Medicare covers certain benefits and supplies specific to people with diabetes, including diabetes drugs, blood glucose monitoring equipment, insulin delivery devices, and therapeutic shoes/inserts. Refer to Medicare and Diabetes Coverage for additional information regarding these provisions, and see the table below to learn w Continue reading >>

Diabetes Health Coverage: State Laws And Programs

Diabetes Health Coverage: State Laws And Programs

Diabetes Health Coverage State Laws and Programs Diabetes Health Coverage: State Laws and Programs This is a policymaker and consumer guide to state insurance mandated coverage, Medicaid coverage and state-sponsored diabetes programs. It was published 2011and updated material was added January 2016 All state law diabetes mandates and minimum coverage requirements for state-regulated health insurance policies. The tables include the enacted state laws passedsince the firstmandates inCalifornia (1981) and New York (1993). Use links below to go directly to state-based information: State Medicaid diabetes coverage terms and conditions. All Children's Health Insurance Program (CHIP) diabetes coverage. Contact information and an overview of federal funding provided by the Centers for Disease Control and Prevention (CDC) to state-sponsored diabetes prevention and control programs (DPCPs). DPCPs represent the front line in battling diabetes in most states. An overview of other state activities and initiatives, such as creation of diabetes coordinator positions in the executive branch to fight diabetes. Federal Health Reform.The federal Affordable Care Act (ACA) signed March 2010, has led to changed and expanded coverage termed "EssentialHealth Benefits." Newly Released: NCSL Survey:Diabetes Drug coverage: A new survey of2016 Insurance Plans in 50 states, examining 1) patient access to the scores of diabetes drug treatments and2) results in the 46 states with laws mandating or offering diabetes coverage. NCSL original research, published summer 2016. [Read the report] December 2015: " Diabetes: Addressing the Costs; A 50-State Budget Survey for FY 2014 ." NCSL released its latest diabetes report, taking a closer look at programs and budget appropriations that play a role in con Continue reading >>

Medicare And Diabetes Technology Insurance Coverage

Medicare And Diabetes Technology Insurance Coverage

I’m still a number of years away from retirement and reaching Medicare age, but I have to admit that the current Medicare coverage (or lack thereof) for diabetes technology causes me to feel more than a little concern. It’s awesome that people with diabetes are living normal lifespans, but the current Medicare system is not set up to provide coverage of the technologies that we become accustomed to using when we have commercial insurance coverage to control the disease as well as we can. When you are young and have commercial health insurance, you use tools like brand name, accurate glucose meters, Continuous Glucose Monitors (CGMs), and insulin pumps. Depending upon your insurance, you may have some restrictions on certain products, or pay more than you would like in co-pays. But the technology or products you want are often not out of reach. Many of the glucose meters on the market have programs which lower your co-pay for test strips. You pay a co-pay and get your insulin. You might prefer to use Novolog but your insurance pays for Humalog, but at least you can get your products. You can probably get an insulin pump if you have Type 2 diabetes if you want one and your physician prescribes it. And you can get a new insulin pump every four years when the old one goes out of warranty. There can be a lot of variation in what is covered, and how much you pay out of pocket, depending upon your insurance coverage. I realize that some people on commercial insurance have it a lot better than others. Did you know that Medicare doesn’t cover insulin pumps the same way that commercial insurance does? They require a test to prove that you don’t make your own insulin and need an insulin pump, as opposed to just wanting one to improve your diabetes management. Type 1s can q Continue reading >>

Asknadia: Why Doesn’t Medicare Cover The Omnipod Insulin Pump

Asknadia: Why Doesn’t Medicare Cover The Omnipod Insulin Pump

Whys doesn’t Medicare cover the OmniPod tubeless insulin pump? I sure wish it was covered. Cathy diabeteshealth.com Subscriber Dear Cathy, Medicare has their own formula for calculating what is medically necessary for medical devices, which they classify as “Durable Medical Equipment” also known as DME. Insulin pumps and blood glucose meters are classified as medically necessary under the Medicare DME coverage. Medication like insulin for an insulin pump, is also considered medically necessary. The issue with the OmniPod coverage under the Medicare classification, is how the OmniPod device delivers the medically necessary part, which is the case is the insulin. Medicare covers other insulin pumps that use infusion sets because the insulin pump itself is classified as a device which is necessary in delivering the insulin. By definition insulin pumps that require tubing to deliver the insulin is medically necessary and is covered under Medicare benefits. Medicare does not cover the OmniPod system because they view the OmniPod system as being two separate items; the tubeless insulin pods and the Personal Diabetes Manager (PDM). Although the insulin is considered medically necessary, the tubeless insulin pods that delivers the insulin is disposable, which disqualifies it as being medically necessary. The Personal Diabetes Manager (PDM) is also disqualified as a medically necessary device because it does not deliver the insulin which medicare classifies as not being medically necessary. I believe everyone should have a choice on how to best manage their diabetes. This includes the medical devices they choose for better diabetes mangement and outcomes. Medicare covers insulin pumps because it offers tighter control and benefits people living with diabetes. This includes Continue reading >>

Medicare Coverage For Diabetes Services And Supplies

Medicare Coverage For Diabetes Services And Supplies

Diabetes is a condition where your body lacks the ability to use blood glucose (blood sugar) for energy, according to the Centers for Disease Control (CDC). As a result, diabetics may have high blood glucose levels. In diabetics, the pancreas typically doesn’t make or use the insulin hormone efficiently. Your body uses insulin to turn sugar (glucose) into energy. Unused sugar can build up in your blood and cause both short-term and long-term problems. Diabetes can be diagnosed with a simple blood test. Many older Americans have type 2 diabetes, where your body doesn’t produce enough insulin or develops resistance to it, according to the CDC. However, even adults can get type 1 diabetes, which used to be called juvenile diabetes. Medicare covers certain medical services and supplies for individuals who have diabetes or at risk for this condition. Medicare coverage for diabetes screenings If you have Medicare and your doctor considers you at risk for diabetes, you may be eligible for up to two blood sugar screenings per year under Medicare Part B ; you don’t pay anything for the screening itself if you use a Medicare-assigned provider at a Medicare-approved facility. However, you may have to pay 20% of the Medicare-approved amount for the visit to the doctor’s office. Risk factors that may qualify you for a Medicare-covered diabetes screening include: High blood pressure History of abnormal cholesterol and triglyceride levels Obesity History of high blood sugar Family history of diabetes Older age (risk for type 2 diabetes increases with age) Reduced blood sugar tolerance High blood sugar levels when fasting Medicare coverage for diabetes patients If you’re diagnosed with diabetes, Medicare may cover services and supplies you will need to treat and control diabe Continue reading >>

Medicare And Cgm Debate

Medicare And Cgm Debate

You may find it hard to believe, but continuous glucose monitors have been around for quite a few years not. Almost all private insurance carriers are not covering them for patients with type 1 diabetes. There has been a battle amongst those advocating for better technology access for patients and the Centers for Medicare and Medicaid Services for almost 10 years now in terms of coverage for a CGM. It’s an amazing step forward that those with diabetes are now living normal life expectancy. But the current coverage set up for those with diabetes in the Medicare system is limiting coverage on a lifesaving technology. For younger patients with diabetes on commercial / private health insurance plans, tools like brand name glucose meters and strips, CGMs, and even insulin pumps are covered for the most part. The technology isn’t without of reach for a majority of individuals. What’s even better is when an insulin pump goes out of warranty a new one can be ordered every four years. There may be some variety in insurance coverage but a vast majority of patients have access to all these supplies and devices. I recommend these articles: Medicare is Different In terms of coverage for insulin pumps, Medicare really makes patients jump through hoops before they will even consider it. They require that a patient undergoes a test to prove they are not making their own insulin and that they really need an insulin pump. Patients are not able to request one because they want to improve their management. Medicare will only pay for an insulin pump for individuals who quality every 5 years, so that means patients are spending one year using an insulin pump that is out of warranty. While this is a shocker, there are even limits on the types of pumps they will pay for. Let’s Talk Abo Continue reading >>

Asknadia: Why Medicare Covers Some Insulin Pumps

Asknadia: Why Medicare Covers Some Insulin Pumps

AskNadia: Why Medicare Covers Some Insulin Pumps I was thinking about getting an insulin pump, but I am worried that Medicare will not cover it. Why does Medicare cover insulin pumps for some people and not for others? Insulin pumps are covered under Medicare if you meet their insulin pump management criteria, insulin antibody test or C-Peptide test. If you are thinking about getting an insulin pump, this is what you need to do. Anytime someone asks me about going on an insulin pump; I recommend they speak to someone who is wearing a pump or go to an insulin pump support group. The wisdom you gain from exploring these two venues is invaluable. After speaking to people who wear a pump, you will either decide it is the best thing for your blood sugars or too labor intensive and might try something else to achieve better blood sugar levels. Working with Your Healthcare Professional Healthcare professionals are great at identifying who is best suited for an insulin pump. They know if you can benefit from using an insulin pump to achieve better blood sugars based on their experience with you and your medical chart. Start a discussion with your healthcare professional who knows you and has access to your medical history. Lets assume your healthcare professional thinks you will benefit from using an insulin pump because you meet the Medicare A or B criteria. Lets also assume you have had an opportunity to speak to people that wear pumps and are very excited about getting started in qualifying for one; the formula below is the process Medicare uses to evaluate insulin pump coverage requests. Medicare A Criteria is For New Insulin Pumpers 1- You must be on multiple injections and able to self-adjust your insulin for six months prior to going on an insulin pump. This means you t Continue reading >>

Diabetes Societies Aim To Gain Medicare Coverage For Cgms, Omnipod

Diabetes Societies Aim To Gain Medicare Coverage For Cgms, Omnipod

Diabetes Societies Aim to Gain Medicare Coverage for CGMs, OmniPod Ongoing efforts from several fronts are aimed at convincing the US Centers for Medicare and Medicaid Services (CMS) to change its coverage plans for Medicare, which currently exclude several diabetes technologies that don't fit the agency's narrowly defined categories for reimbursement. Although most private insurers now cover personal-use continuous glucose monitors (CGMs) and the insulin-delivery device OmniPod (Insulet Corporation) for patients who meet certain clinical criteria, Medicare doesn't. And neither do about 20 state Medicaid programs that follow Medicare's lead. Thus, Medicaid patients in those states can't get these devices, while those who have been using them for long periods of time both CGMs and OmniPod have been on the US market for over a decade are forced to give them up or pay out of pocket for the supplies when they age into Medicare. "[CMS officials] just want to be within the bounds of the law. But as a clinician I deal with all these headaches. When patients turn 65 they lose the OmniPod and CGM," George Grunberger, MD, head of the Grunberger Diabetes Institute, Bloomfield Hills, Michigan, and immediate past president of the American Association of Clinical Endocrinologists (AACE), explained to Medscape Medical News. Issue Relates to Definition of "Durable Medical Equipment" With both devices, the problem relates to the definition of "durable medical equipment," which applies solely to the active part of devices under Medicare Part B. In the case of CGMs, the "active" part the sensor inserted beneath the skin is discarded after being worn for 6 or 7 days (CGMs from Medtronic and Dexcom, respectively). Both systems also include battery-powered transmitters either rechargeable ( Continue reading >>

Medicare Coverage For Patients With Diabetes

Medicare Coverage For Patients With Diabetes

Go to: DIABETES: RISING MEDICARE POPULATION AND ECONOMIC BURDEN Considered by many to be an emerging pandemic, the increasing prevalence of diabetes in the United States population over the past half-century is a growing concern. According to the Centers for Disease Control (CDC), the total number of individuals reported to have diabetes in the United States has more than doubled from 5.8 million in 1980 to 14.7 million in 2004.1–3 Factors proposed to account for the increase of people in the United States diagnosed with diabetes include changing diagnostic criteria, improved or enhanced detection, increased awareness, growth in minority populations, obesity and lifestyle factors, and decreased mortality.4–6 A major increase in the prevalence and incidence of diabetes has been noted among Medicare beneficiaries age 67 or older. Between 1993 and 2001, the adjusted prevalence of diabetes cases per 1,000 individuals in the elderly Medicare population rose from 145 to 197. The highest prevalence rates were noted among minority groups. Between 1994 and 2001 the adjusted incidence of diabetes in beneficiaries age 67 or older increased 36.9%, from 27/1,000 to 37/1,000.6 By 2050, the number of people with diabetes is expected to increase by 165%, with the greatest increase expected among individuals age 75 or older.7 The economic burden attributed to diabetes has paralleled population trends. According to the American Diabetes Association (ADA), in 2002 direct medical and indirect expenditures attributed to diabetes in the United States were $91.8 billion and $39.8 billion, respectively. Individuals age 65 or older bore the majority of the estimated costs at $47.6 billion. Costs for insulin and delivery supplies, oral agents to lower blood glucose, and other outpatient medi Continue reading >>

Medicare Will Pay For Insulin Pumps

Medicare Will Pay For Insulin Pumps

A.������� The patient has completed a comprehensive diabetes education program, and has been on a program of multiple daily injections of insulin (i.e. at least 3 injections per day) with frequent self-adjustments of insulin dose for at least 6 months prior to initiation of the insulin pump, and has documented frequency of glucose self-testing an average of at least 4 times per day during the 2 months prior to initiation of the insulin pump, and meets one or more of the following criteria while on the multiple daily injection regimen: ����������� 1.�������� Glycosylated hemoglobin level (HbA1c) greater than 7.0% ����������� 2.�������� History of recurring hypoglycemia ����������� 3.�������� Wide fluctuations in blood glucose before mealtime ����������� 4.�������� Dawn phenomenon with fasting blood sugars frequently exceeding 200mg/dL ����������� 5.�������� History of severe glycemic excursions B.�������� The patient with type 1 diabetes has been on a pump prior to enrollment in Medicare, and has documented frequency of glucose self-testing an average of at least 4 times per day during the month prior to Medicare enrollment. Other Requirements: ����������� Type 1 diabetes needs to be documented by a C-peptide level less than 0.5. ����������� The pump must be ordered by, and follow-up care of the patient must be managed by a physician who manages multiple patients with CSII (pump therapy), who works closely with a team including nurses, diabetes educators, and dietitians who are knowledgeable in the use of CSII. Continue reading >>

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