Key Takeaways:
- On January 1st, 2024, CMS billing guidelines are making a shift from 90-day billing cycles to monthly billing cycles.
- Medicare Part B deductible is changing to $240 in 2024.
- Dexcom G7 and FreeStyle Libre 3 System are available through Medicare.
- Coverage criteria dropped in 2023, so you can recheck your eligibility for CGMs through insurance if you were denied in 2023.
This time each year, Original Medicare changes its deductibles, premiums, and coinsurance costs. January is also a time for those who need coverage to switch to a Medicare Advantage plan. The Centers for Medicare & Medicaid Services (CMS) are also changing their continuous glucose monitoring system billing guidelines in 2024.
All of these circumstances can result in changes in coverage if you use continuous glucose monitors (CGMs) to manage your blood glucose levels without painful fingersticks.
Whatever the case may be, we’re here to answer your questions. Read this post to learn more about Medicare plans in the new year and find out if you can get your CGM supplies delivered to your home with Aeroflow Diabetes.
Medicare Plans & Start Dates
The General Enrollment Period for Medicare ran from October 15 - December 7, 2023. If you signed up for Medicare during this time, your coverage will begin the month after you signed up for your health insurance plan.
You may have signed up for an Original Medicare plan or a Medicare Advantage plan.
- Original Medicare: Includes Medicare Part A and B. Recipients pay for healthcare services as they get them and pay deductibles. With this plan, you need to pay for Medicare Part D (prescriptions) separately.
- Medicare Part B: Covers physician services, outpatient hospital visits, some home health services, durable medical equipment (DME), such as catheters, and other health services.
- Medicare Part A: Covers inpatient hospital visits, hospice, skilled nursing facilities, lab tests, surgeries, and home health care.
- Medicare Advantage: Covers everything Original Medicare does, however, most plans also cover Medicare Part D. You may receive Medicare Advantage plans through insurers such as Aetna, Blue Cross Blue Shield (BCBS), etc. These are sometimes referred to as Medicare Part C.
- Medicare Part D: Covers prescriptions, vaccines, and immunizations.
Recipients do not pay a premium for Part A (or if they don’t qualify for premium-free Part A, they can purchase Part A separately) and pay a premium for Part B.
Why Might My Coverage Change?
Your CGM coverage may change for a few reasons.
1. You may be switching to a Medicare Advantage plan.
If you are switching to a Medicare Advantage plan covered by insurers such as Humana, Aetna, Blue Cross Blue Shield (BCBS), etc., your CGM coverage might change from what was covered under your Original Medicare plan.
2. Your Original Medicare plan may change.
Every year, the Medicare Part B premium, deductible, and coinsurance rates are subject to change due to the Social Security Act. For example, 3 years ago, the Medicare deductible was $185, and in 2022, it increased to $233.
3. The coverage criteria for CGMs was dropped in 2023.
In April 2023, the CMS coverage criteria dropped, resulting in more than 1 million Medicare health plan beneficiaries now being eligible for CGMs through insurance. If you were denied CGM coverage in 2023, you may now qualify! Recheck your eligibility now.
2024 Medicare Changes
If you stick with your Original Medicare plan in the new year, you will see a few cost changes that may affect how much you pay out of pocket for CGMs. These changes will occur in 2024:
- Standard monthly premium for Medicare Part B recipients will increase from $170.10 to $164.90.
- Annual deductible for Medicare Part B recipients will increase from $226 to $240.
- Billing cycles will switch from 90-day billing to monthly cycles.
What CGMs Will Be Available Through My Medicare Plan?
We can’t say specifically which CGMs will be available to you in 2024 since coverage is different for every person depending on their insurance plan. However, your Medicare plan may cover the CGMs we supply.
How to Get CGMs Through Medicare
Want to find out which CGM systems you can get at low-cost through your Medicare plan so you can more easily manage your blood sugar levels and make your overall diabetes management simpler?
Our Aeroflow Diabetes experts can tell you quickly- all you need to do is fill out our short Eligibility Form! It takes under 5 minutes to complete. We keep your information private and we’ll determine your coverage based on your insurance company’s requirements, taking the confusion out of insurance paperwork. Plus, your out-of-pocket costs may decrease, saving you money in the new year.
If you do qualify, we’ll reach out to your healthcare provider for a CGM device prescription. We’ll then guide you through which CGMs you can receive through your insurance coverage and mail your order right to your doorstep!
Jump To: Top | Eligibility Form
References
2023 Medicare Parts A & B Premiums and Deductibles 2023 Medicare Part D Income-Related Monthly Adjustment Amounts | CMS. (n.d.). Www.cms.gov. https://www.cms.gov/newsroom/fact-sheets/2023-medicare-parts-b-premiums-and-deductibles-2023-medicare-part-d-income-related-monthly
Medicare Open Enrollment | CMS. (n.d.). Www.cms.gov. https://www.cms.gov/priorities/key-initiatives/medicare-open-enrollment-partner-resources
Disclaimer
Information provided on the Aeroflow Diabetes website is not intended as a substitute for medical advice or care from a healthcare professional. Aeroflow recommends consulting your healthcare provider if you are experiencing medical issues relating to diabetes care.
