Aetna MAPD Freestyle Libre questions

[jack3454]

Anyone know off-hand if Aetna MAPD will cover Freestyle Libre CGM out of the gate? I read this EOC like 5 times and it contradicts itself.

Also, the EOC says "CGMs are available though participating DME providers" and then gives a link to DME providers. It then says "also available at participating pharmacies". What even is this? Participating pharmacy for what, selling CGMs? How do you find a participating pharmacy?

 

[goillini52]

Anyone know off-hand if Aetna MAPD will cover Freestyle Libre CGM out of the gate? I read this EOC like 5 times and it contradicts itself.

Also, the EOC says "CGMs are available though participating DME providers" and then gives a link to DME providers. It then says "also available at participating pharmacies". What even is this? Participating pharmacy for what, selling CGMs? How do you find a participating pharmacy?

CGM = ?

 

[jack3454]

CGM = ?

Continuous glucose monitor

 

[bluediamond]

Anyone know off-hand if Aetna MAPD will cover Freestyle Libre CGM out of the gate? I read this EOC like 5 times and it contradicts itself.

Also, the EOC says "CGMs are available though participating DME providers" and then gives a link to DME providers. It then says "also available at participating pharmacies". What even is this? Participating pharmacy for what, selling CGMs? How do you find a participating pharmacy?

Plans must cover all medically necessary services that Original Medicare covers. Plans may also offer some extra benefits that Original Medicare doesn't cover— like certain vision, hearing, and dental services. You can join a separate Medicare drug plan to get Medicare drug coverage (Part D).

chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.medicare.gov/publications/12026-Understanding-Medicare-Advantage-Plans.pdf

Continuous glucose monitors​

Medicare may cover a continuous glucose monitor (receiver) and related supplies (sensors and transmitters) if your doctor says you meet all the requirements for Medicare coverage.
To qualify for a continuous glucose monitor you must:

• Have diabetes mellitus.
• Take insulin or have a history of problems with low blood sugar.
• Have a prescription for testing supplies and instructions on how often to test your blood glucose.
• Have been trained (or had your caregiver trained) to use a continuous glucose monitor as prescribed by your doctor.
• Make routine in-person or Medicare-approved telehealth visits with your doctor.

Continuous glucose monitors

Medicare provides therapeutic continuous glucose monitor (CGM) coverage. Proactively monitor blood sugar, glucose levels, etc. Get more info here.

www.medicare.gov

Have the client call Aetna because Aetna may cover one cgm and not the other.

 

[jack3454]

Plans must cover all medically necessary services that Original Medicare covers. Plans may also offer some extra benefits that Original Medicare doesn't cover— like certain vision, hearing, and dental services. You can join a separate Medicare drug plan to get Medicare drug coverage (Part D).

chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.medicare.gov/publications/12026-Understanding-Medicare-Advantage-Plans.pdf

Continuous glucose monitors​

Medicare may cover a continuous glucose monitor (receiver) and related supplies (sensors and transmitters) if your doctor says you meet all the requirements for Medicare coverage.
To qualify for a continuous glucose monitor you must:

• Have diabetes mellitus.
• Take insulin or have a history of problems with low blood sugar.
• Have a prescription for testing supplies and instructions on how often to test your blood glucose.
• Have been trained (or had your caregiver trained) to use a continuous glucose monitor as prescribed by your doctor.
• Make routine in-person or Medicare-approved telehealth visits with your doctor.

Continuous glucose monitors

Medicare provides therapeutic continuous glucose monitor (CGM) coverage. Proactively monitor blood sugar, glucose levels, etc. Get more info here.

www.medicare.gov

Have the client call Aetna because Aetna may cover one cgm and not the other.

Thank you

 

[rmhaire]

Plans must cover all medically necessary services that Original Medicare covers. Plans may also offer some extra benefits that Original Medicare doesn't cover— like certain vision, hearing, and dental services. You can join a separate Medicare drug plan to get Medicare drug coverage (Part D).

chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.medicare.gov/publications/12026-Understanding-Medicare-Advantage-Plans.pdf

Continuous glucose monitors​

Medicare may cover a continuous glucose monitor (receiver) and related supplies (sensors and transmitters) if your doctor says you meet all the requirements for Medicare coverage.
To qualify for a continuous glucose monitor you must:

• Have diabetes mellitus.
• Take insulin or have a history of problems with low blood sugar.
• Have a prescription for testing supplies and instructions on how often to test your blood glucose.
• Have been trained (or had your caregiver trained) to use a continuous glucose monitor as prescribed by your doctor.
• Make routine in-person or Medicare-approved telehealth visits with your doctor.

Continuous glucose monitors

Medicare provides therapeutic continuous glucose monitor (CGM) coverage. Proactively monitor blood sugar, glucose levels, etc. Get more info here.

www.medicare.gov

Have the client call Aetna because Aetna may cover one cgm and not the other.

And this:

Make sure the client is using a preferred pharmacy in a situation like this.
Medicare will pay for monitors and supplies. But not always when it's a standard pharmacy.

 

[ValeRosso]

I cant speak for the entire country but Aetna has covered Freestyle in all of my cases. Its in the EOC