Continuous Glucose Monitors, or CGMs for short, are a relatively new way to monitor your blood sugar levels.
Using a CGM, as opposed to older methods, is a less invasive and less painful way to track your blood sugar levels. This is a significant advancement in the medical industry. A popular CGM model is the Medtronic 670g.
If this is a device that you think you or a loved one could benefit from, a common question many people have is, “Does Medicare cover The Medtronic 670g?”
In this article, we answer the question in clear, plain English. You will also find the average cost of the Medtronic 670g for those who have to pay out of pocket.
Does Medicare Cover The Medtronic 670g?
The short answer is yes. Medicare will cover the cost of Medtronic 670g. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your Medtronic 670g. Below we look at what these are so you know what to expect.
Original Medicare Coverage of The Medtronic 670g
Original Medicare (Medicare Part A and Part B) provides coverage for Medtronic 670g. This plan provides coverage for your Medtronic 670g if it is considered medically necessary.
Your healthcare provider must first order the treatment for Original Medicare to provide coverage.
Is The Medtronic 670g Covered by Part A or Part B?
As you may know, Part A covers inpatient services, while Part B covers outpatient services.
In our case, coverage for Medtronic 670g is provided by Medicare Part B.
One important thing to understand is that the Medtronic 670g is considered a prosthetic device. Prosthetic devices are labeled as Durable Medical Equipment or DME, which Medicare Part B covers.
However, for Medicare Part B to provide coverage for your Medtronic 670g, it must be ordered by your healthcare provider. Your healthcare provider and your DME supplier must be enrolled in Medicare for Medicare Part B to provide coverage.
Once approved, Medicare Part B covers 80 percent of the costs of your Medtronic 670g. You will pay for the remaining 20 percent as a copayment or coinsurance.
Additional Information on Part B Coverage
The U.S. Centers for Medicare & Medicaid Services, also known as CMS, recently expanded their Medicare coverage for all types of CGMs.
This coverage expansion includes CGMs that integrate with Medtronic insulin pumps. The expanded coverage will be effective after 60 days of the announcement.
Medicare Part B provides coverage for the following diabetic supplies:
- Supplies that you can use for testing and checking your blood sugar such as CGMs, blood glucose test strips, and lancets
- Insulin pump but only the tubed type along with the insulin that will be used
- Usually, two preventive diabetes screenings per year
- Foot exams every six months
- Durable Medical Equipment such as shoe inserts and special shoes
- Diabetic-related eye tests such as glaucoma tests, macular degeneration tests, and cataract tests
- Diabetic education to manage diabetes
- Medical nutrition therapy
Medicare Advantage Coverage of The Medtronic 670g
Finally, the Medicare Advantage plans (Medicare Part C) also provide coverage for Medtronic 670g. They cover everything Original Medicare covers, as well as some additional benefits.
However, exactly what it covers and how much the out-of-pocket costs will vary depending on the specifics of your plan.
What is the Cost of The Medtronic 670g?
Currently, without any coverage, the Medtronic pump costs about $7500.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. Always be sure to double-check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series, including: Does Medicare Cover Methadone Treatment?