Hi, I was wondering how I could get a sensor with better insurance coverage? Right now my pharmacy is charging me over $200 for 10 Libre sensors even though I’ve met my out of pocket costs and deductible. Is it more likely for insurance companies to cover Dexcom? I’m afraid I’ve become super reliant on the sensor and don’t want to do without it, but I also don’t want to spend that much money.
Thank you!
Hi Kimberly @kimberlyelaine, the best way to go about this is to ask YOUR current insurance carrier or plan administrator what / which glucose monitors are covered by your plan. Coverage for supplies can vary between plans in the same insurance company.
Good luck in your investigation. Right now I’m investigating plans to which I will change for Medicare Advantage because I’ve found that my otherwise awesome coverage with United Health doesn’t meet always my needs for pumps and CGM; for instance my coverage only covers Medtronic “non-current” pumps and United won’t talk with Dexcom.
Thank you so much for the advice Dennis! I will definitely look around to see what works best. I’m on a student health insurance plan (aetna) that ends this month so I will have to look for a temporary insurance plan until I begin work in September. I was thinking blue cross blue shield, but I will have to look into their coverage of cgms.
Kimberly, keep in mind that in place of finding a “temporary” policy, you may be able to continue, at cost, your current coverage.
The health insurance portability act of the later 1980’s [HIPA] included this provision.
I didn’t know that, that’s really good to know! Thank you again Dennis!
Every Health Insurer is different and how they cover a CGM can also vary between a Pharmacy Coverage vs Insurance durable medical equipment. Copays and deductibles are the new way for insurers to minimize their out of pocket. Freestyle Libre is the lowest cost CGM when you compare Cash prices between Dexcom and Abbott, e.g. ~42.00 at CVS, ~40.00 Walmart for the Libre. Dexcom doesn’t sell to retail pharmacies, you have to use Byram or Solaris. If your insurance is similar to my Bluecross, I had to satisfy a 2,500 deductible before insurance would start paying their share of CGM and pump supplies. The deductible can be satisfied by other medical expenses, so I usually just come up with most likely scenarios of medical expenses that I can predict. You need 36 sensors a year, buying them without insurance will cost you 1455.88 cash price at Walmart. No tax is charged if you have a Dr script. 200 seems like a big co-pay, but not the biggest I have paid, but it is less then the cash price.
Somethings also can go under durable medical and not thru pharmacy. I get my daughters dexcom thru a 3 rd party and it is covered under durable medical. For me it’s cheaper then pharmacy route.
This is all good to know. Thank you!
A little perspective: if Libre sensors last 10 days and you’re paying $20 per sensor, that’s about $2 per day. I think you’ll find the peace of mind that comes with CGM is likely to be worth that much. Cheaper is better, of course, but when I first calculated how much it would cost - back when my insurance didn’t cover CGM at all - it came to $6 per day. It was definitely worth it! I’m glad it’s cheaper now, but I definitely don’t regret it.
Call your insurance company and ask if they have a “preferred” distributor for your testing supplies.
For years, I was paying astronomical costs for my pump supplies. When I looked into getting a Dexcom, Dexcom said I would need to get their product from a preferred distributor, for my insurance to cover it.
They put me in contact with the preferred distributor and I found my pump supplies were hundreds of dollars cheaper!
Your insurance company won’t tell you, unless you ask. You’re saving them money, when you are uninformed.