What’s The Importance Of A Benefit Year
Typically , health insurance policies are done on an annual basis, and things like deductibles and out-of-pocket maximums, which act like thresholds, are reset. Youll usually find your cost to be lower later in the benefit year after theyve been met .
For many, the benefit year is the same as a calendar year, so the end of the year might be a smart time to ask about your coverage again. You might be in for a pleasant surprise for the holidays!
How Does A Continuous Glucose Monitor Work
A CGM works through a tiny sensor inserted under your skin, usually on your belly or arm. The sensor measures your interstitial glucose level, which is the glucose found in the fluid between the cells. The sensor tests glucose every few minutes. A transmitter wirelessly sends the information to a monitor.
The monitor may be part of an insulin pump or a separate device, which you might carry in a pocket or purse. Some CGMs send information directly to a smartphone or tablet. Several models are available and are listed in the American Diabetes Associations product guide.
Continuous Glucose Monitoring Cost
A continuous glucose monitoring system is designed to offer a continuous readout of the glucose levels in the tissue fluid, and in order for the device to work, you will insert a sensor beneath your skin, similar to that of a needle stick, according to Diabetes Self-Management.
Made of similar filters used in dialysis, this FDA-approved device continuously measures your glucose levels, all while sending the results to a nearby connected device, usually the size of a small piece of paper every five to 15 minutes.
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Benefits And Downsides Of A Continuous Glucose Monitor
Continuous glucose monitors, as well as any other type of medical device, has its upsides and downsides.
Upside: Increased peace of mind
Those who have worn this device have said the best thing about CGMs is the freedom and peace of mind they feel.
A continuous glucose monitor can alarm when sugar levels are trending in the wrong direction. For active people, a CGM can give them a full picture of their blood glucose without stopping to prick their fingers.
Upside: Increased visibility and control
Because a continuous glucose monitor is constantly monitoring blood sugar levels, the data that is collected is extremely useful to both the person wearing it and their physician.
While a glucometer gives a momentary snapshot of the current blood sugar level, a CGM can offer the full story offering data that shares trends that can associate with activities or food.
Upside: CGM may help avoid complications
Those who deal with hypoglycemia unawareness could benefit from continuous monitor to help avoid hypoglycemic complications. Using a continuous glucose monitor during sleep could help those who would not have a reading otherwise.
This also offers peace of mind of not having to set a 3 am alarm to check blood sugar levels.
Downside: Continuous glucose monitoring cost
This compounded with the fact that youd still need to purchase insulin, insulin delivery systems and glucometer test strips could be a deal-breaker for those on a budget.
How To Get A Continuous Glucose Monitor Without Health Insurance
Diabetes is a costly disease in many ways. Accessing critical diabetes supplies like continuous glucose monitors and medication like insulin is a problem for many people.
If you are struggling to afford the medication and supplies you need to survive, utilize these resources:
Pricing is still one of the most significant barriers people with diabetes face in accessing a CGM. Here are some actionable tips if you do not have insurance and are trying to get one.
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What Is Continuous Glucose Monitoring
A CGM is a compact medical system that continuously monitors your glucose levels in more or less real time .
To use a CGM, you insert a small sensor onto your abdomen with a tiny plastic tube known as a cannula penetrating the top layer of skin. An adhesive patch holds the sensor in place, allowing it to take glucose readings in interstitial fluid throughout the day and night. Generally, the sensors have to be replaced every 7 to 14 days.
A small, reusable transmitter connected to the sensor allows the system to send real-time readings wirelessly to a monitor device that displays your blood glucose data. Some systems come with a dedicated monitor, and some now display the information via a smartphone app, so you dont even need to carry an extra device around with you.
Aside from the constant stream of data, most CGMs can send alerts telling you when your blood sugar levels are rising too high or dropping too low. You can also set the alert parameters and customize how youre notified.
Its not an understatement to say that CGMs have revolutionized diabetes care. Unlike a traditional fingerstick , which provide just a single glucose reading, CGMs provide continuous, dynamic glucose information every 5 minutes. That equates to roughly 288 readings in a day.
How Do I Get A Cgm
As with most medical technology, you need a prescription to get a CGM. Your doctor can write a prescription for any of the above CGM devices.
But getting a prescription for a CGM is often not as simple as just walking into your doctors office and asking for one. Instead, youll likely need a prior authorization to get a CGM through your health insurance. A PA is form/process that your doctor has to go through to prove medical necessity to obtain approval from your insurance plan to cover the costs associated with the prescribed treatment .
At this point, most major insurers require a PA before extending coverage for CGM. Heres how to go about securing a PA, according to JDRF, a leading T1D research and support organization:
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Got A Costco Near You Check Their Prices To See If Theyre Better
Sometimes, having a wholesale membership from Costco or Sams Club may save you a little money on the newest CGM technology without insurance. While this is not always the case, its still worth investigating in the cost-savings process!
Here is the 2022 cost breakdown of popular CGMs like the Freestyle Libre 2 and Dexcom G6 on Costcos website.*:
*This is just one example of popular CGM device pricing on a specific date in time. Exact costs may vary depending on patient circumstances, at what point in the future you fill your prescription and the location. Always contact your local Costco, Sams Club, or other pharmacies for exact prices on CGM supplies you want to fill without running insurance in your area.
Cons Of A Glucose Monitoring System
Is it real-time? As with a lot of at-home medical devices, the numbers can lag since it can take glucose up to 10 minutes to move from your blood into your tissue fluid, effectively meaning these numbers are not truly real-time numbers.
Still need a standard fingerstick: These devices should not replace the standard fingerstick test because, as mentioned above, you will still need to use this type of test to calibrate the machine, making it an ongoing job.
High costs: Some find the costs not worth it as the total start-up costs can far exceed $2,000 in the first year.
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Research Design And Methods
In the Multiple Daily Injections and Continuous Glucose Monitoring in Diabetes trial, 158 patients with T1D and HbA1c7.5% were randomized in a 2:1 ratio to CGM or control. Participants were surveyed at baseline and 6 months. Within-trial and lifetime cost-effectiveness analyses were conducted. A modified Sheffield T1D policy model was used to simulate T1D complications. The main outcome was cost per quality-adjusted life-year gained.
Who Has The Best Price On Cgms
Pharmacies can price the sensors however they like. So I recommend you do your homework before bringing them your prescription.
Ive seen the price as low as $37/sensor for the FreeStyle Libre products. But Ive also seen them for over $100 each!
The Costco Pharmacy seems to have the lowest price across the country. Sams Club might be the the name where you live. You can use the Costco pharmacy even if you are NOT a member.
Fred Meyers/Krogers and Walmart also tend to have good prices.
I recommend calling your pharmacy to ask their cash price. If the price is over $40/sensor for the FreeStyle Libre products, shop around. Call the other pharmacies in your area to find out their prices and have your prescription sent there.
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When Money Isnt The Only Hurdle
David Grigsby spent much of his life monitoring his diabetes without a continuous glucose monitor. It took a particularly dedicated health care provider to persuade him to try the device that he says changed his life. But even after he realized how much he loved it, it wasn’t always easy to access it.
Grigsby, a longtime resident of Tucson, was 22 when he found out he had diabetes. He had awakened one day with extremely high blood glucose levels, though he didnt know it. He crossed the street to the 7-Eleven to get a Big Gulp.
After he drank it, he started feeling sick.
He called his mother, and she took him to the hospital. There, he says, he fell into a coma for about four days.
When I woke up, I was like, what’s going on? Grigsby said. And so the doctor was telling me that I’m a diabetic and things gonna get kind of rough for a little while.
Even after he was discharged, he was blind for over a week.
I wouldnt wish diabetes on my worst enemy, he said. Diabetes is nothing to play with. It can destroy you.
Gradually, he got his vision back, but what followed was over 30 years of learning to manage his condition. And though continuous glucose monitors have been around for much of that time the FDA approved the first professional CGM to be administered by doctors in 1999, and device companies were rolling out hyper- and hypoglycemia warning devices for diabetics personal use by 2004 Grigsby didnt start consistently using a CGM until last year.
What About Health Insurance Coverage
Its helpful to know that the Dexcom G6, Abbott FreeStyle Libre 2, and Eversense implantable CGM are all covered by most private and public health insurance plans, including Medicare . Medtronics Guardian Connect, however, was not covered by Medicare as of December 2021.
Historically, people with type 1 diabetes have had a much easier time qualifying for a CGM through insurance than those with type 2 diabetes because it was easier to establish medical necessity.
Still, if you have T2D and your doctor can make a case for medical necessity, you may qualify. But your insurance company may still want to confirm whether you actually need a CGM.
If you can prove youre experiencing both high blood sugars and low blood sugars regularly, you will likely qualify. This can be proven by providing blood glucose logs uploaded from your fingerstick meter. Generally, hyperglycemia is defined as a blood glucose level of 250 mg/dL or over, while hypoglycemia is a blood sugar 70 mg/dL or below.
If your insurance company denies your coverage for a CGM, talk with your doctors office about peer-to-peer reviews and appeals. Pushing your doctor to fight for you matters.
Manufacturers can have your back here, too. Dexcom, for instance, has an easy-to-complete patient information form you can submit along with your insurance information. The company will then contact your insurer to work on getting your device authorized and covered. Medtronic offers a similar service.
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When Might I Need To Do A Fingerstick Check When Using A Cgm Device
You may need to do fingerstick checks to calibrate a CGM device. Either way, youll likely still need to do fingerstick checks to look at your blood glucose in certain situations.
For example, a fingerstick check may give you peace of mind if your CGM device shows rising or falling numbers, but you feel OK. It can also provide answers if you dont feel well, but the CGM says your glucose levels are in target.
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Abbott Freestyle Libre 2
The Abbott FreeStyle Libre Flash Glucose Monitoring system is growing in popularity, especially now that the latest Abbott FreeStyle Libre 2 model offers optional real-time alerts that can notify users about high and low glucose levels.
As of mid-2021, the Abbott FreeStyle Libre 2 still requires a separate hand-held reader to scan the circular sensor you wear on your upper arm for up to 14 days.
Abbott FreeStyle Libre 2 launched in late 2017 and is available through national pharmacies like Costco, CVS, Kroger, Walgreens, and Rite Aid. Abbott tells DiabetesMine that most Abbott FreeStyle Libre 2 users in the United States are getting their sensors through retail pharmacies.
Notably, Abbott says the FreeStyle Libre 2 costs 70 percent less than the list price of other CGM systems currently available in part because it doesnt require a separate transmitter with each sensor like the competing products do.
Here are the approximate prices for the Abbott FreeStyle Libre 2 system in pharmacies:
- sensors: list price of $54 per 14-day sensor, according to Abbott generally $58 to $69 at retail pharmacies like Costco and Walgreens
- with commercial insurance, most people pay between $10 and $75 per month for the Abbott Libre 14-day sensors at participating pharmacies
- hand-held reader: $70
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Medtronic Minimed Guardian Connect
Many think that the Medtronic Minimed Guardian Connect CGM is only integrated into the companys Minimed insulin pumps, but there is also a stand-alone CGM available. The Medtronic Minimed CGM requires a separate seashell-shaped transmitter that connects to each sensor that is worn for 7 days.
Medtronic doesnt sell its CGM sensors and supplies at pharmacies, but you can find these at mail-order distribution companies and directly through Medtronics online store.
- a transmitter : $620
- Medtronic Minimed Guardian Connect CGM sensors : $345
- estimated total: $4,208 per year, or $351 per month
Best Continuous Glucose Monitors For 2022
If you’re considering switching to a continuous glucose monitor, try one of these.
Mercey Livingston is a health and wellness writer and certified Integrative Nutrition Health Coach. She’s written about fitness and wellness for Well+Good, Women’s Health, Business Insider, and Prevention.com among others. When not writing, she enjoys reading and trying out workout classes all over New York City.
Those with Type 1 or Type 2 diabetes must monitor their blood sugar and keep it in check. It’s a huge priority, and while no one loves pricking their fingers all day and testing their blood, it needs to be done. Traditional blood glucose monitors can be a pain, but there is another option. Continuous glucose monitoring systems, aka CGM devices, are much more convenient and can be worn and used for long periods of time. This makes checking your blood sugar a breeze compared to other methods.
“Continuous glucose monitors offer more intensive monitoring of a diabetic patient’s sugar levels,” said Dr. Rebecca Fenichel, an endocrinologist at Westmed Medical Group. “They are particularly well suited to patients who have to check multiple times a day, or to patients who want to get more frequent feedback during the day.”
For this article, we’ve consulted doctors, including Fenichel, and researched the most popular monitors to curate the best continuous glucose monitors on the market for 2022.
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How Do Continuous Glucose Monitoring Devices Work
You can choose among a handful of CGM devices available today. Each works pretty much the same way. The main differences are in a devices look, feel and features.
In general, heres how CGM works: