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Who Has Best Cell Phone Coverage In My Area – Coverage for continuous glucose monitoring varies by state Medicaid program, see our guide to coverage and coverage.
California is the latest state to expand access to continuous glucose monitors (CGMs) under its Medicaid program, Medi-Cal. Although Medi-Cal originally limited CGM coverage to children with diabetes, it later expanded CGM coverage to all people with type 1 diabetes. The policy will take effect in January 2022. In California, Medi-Cal covers 25 percent of the population , and the Children’s Health Insurance Program (CHIP), a federal and state-supported program for low-income Americans. We estimate that at least half of these beneficiaries have diabetes, prediabetes or undiagnosed diabetes. For these individuals, diabetes drug coverage and technology greatly increase their chances of living a complication-free life.
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Despite advances in Medi-Cal access to CGM, California and 22 other states still do not provide CGM services to all diabetics who need CGM. A CGM is essential for providing regular blood glucose readings to track time spent in range, identify behavioral and blood glucose patterns, and predict hypoglycemia and hyperglycemia. The device all but eliminates the need for a finger stick and has been shown to be better than self-monitoring of blood glucose in lowering A1C, reducing hypoglycemia, and extending time in the insulin range in both type 1 and type 2 diabetic patients. blood sugar and improvements in this time range lead to fewer hospital admissions and long-term complications, resulting in significant savings for the health care system.
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CGMs are covered by most private insurance, as well as Medicare Part B, the federal health insurance program that covers people age 65 and older or those with disabilities. Clearly, the benefits of CGM summarized above should be available to everyone on Medicaid, and many in the advocacy community are working to ensure progress in this area.
While Medicare benefits are the same across the country, Medicaid primarily covers low-income adults, children, pregnant women and some parents, but varies from state to state. In states that have chosen to expand Medicaid under the Affordable Care Act (ACA), people are eligible for Medicaid if their income level is below 133 percent of the federal poverty level. As a result, more people are covered and insured in states that expand Medicaid coverage. In underdeveloped states, many people do not qualify for Medicaid and cannot purchase subsidized private health plans through the health insurance marketplace.
It depends. In states that expand Medicaid, more people with diabetes can receive Medicaid coverage benefits, which may include access to continuous glucose monitoring (CGM), depending on the state. But even if CGM is covered by your state’s policy, each state has its own criteria for who qualifies for it. For example, some states only cover CGMs for type 1 diabetes, while others have different policies for short-term and long-term CGM use. To find out more about the policy in your country, please see the map below:
This map is a big picture of Medicaid CGM coverage. Six states shown in red (Arizona, Florida, Hawaii, Kansas, Nebraska, and New Jersey) do not offer publicly available CGM coverage policies for Medicaid beneficiaries, while the others offer some level of Insured, as indicated in the legend.
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Medicaid programs in 15 states only provide CGM to people with type 1 diabetes: California (effective 2022), Louisiana, Maryland, Michigan, Mississippi, Missouri, Nevada, New York, Oregon, Ro Texas, South Carolina, South Dakota, Tennessee, Wisconsin and Wyoming.
27 state Medicaid programs (and DC) offer CGM to people with type 1 and 2 diabetes: Alaska, Arkansas (effective 2022), Colorado, Connecticut, Delaware, Idaho, Illinois , Iowa, Indiana, Kentucky, Maine, Massachusetts, Minnesota, Montana , New Hampshire, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Texas, Utah, Vermont, Virginia, Washington and West Virginia.
Although 44 states have some coverage for CGMs, a series of eligibility criteria limit the use of these devices. Almost all states require at least a diagnosis of diabetes, regular visits to an endocrinologist or other health care provider, and self-monitoring of blood sugar at least three times a day. Many states have stricter eligibility criteria. Even for the green states mentioned above, many Medicaid recipients can’t get CGM because they don’t meet the state’s eligibility requirements. Here are some examples of these standards:
Each of the above requirements can be a barrier to performing CGM in diabetic patients. This map provides an overview of Medicaid CGM coverage in the US, but keep in mind that coverage varies by state and many factors can affect your eligibility for CGM. For a definitive answer on whether you are covered, consult your health care provider or your insurance plan’s benefits document.
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National policies that cover CGM through pharmacy benefits (not medical benefits) often make it easier for people to get CGM. Currently, 20 states and the District of Columbia offer CGM through pharmacy reimbursement: Delaware, Illinois, Kentucky, Maine, Massachusetts, Minnesota, Missouri, Nevada, New Hampshire, New York, North Carolina States, North Dakota, Ohio, Oklahoma, Pennsylvania , South Carolina, Utah, Vermont, West Virginia and Wyoming.
Delaware, Illinois, Kentucky, Maine, Massachusetts, Minnesota, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Utah, Vermont State, West Virginia, and Washington, DC, cover CGM for Type 1 and Type 2 patients, making their policy the most effective and extensive of the fifty states.
Obtaining a CGM through pharmacy reimbursement is often faster, easier and less expensive for patients. While both pharmacy and medical benefits require a doctor’s prescription, medical benefits often require more paperwork and documentation from the doctor. Not only does this create a lot of problems for physicians, but it also leads to additional administrative processing and delays in obtaining CGMs for diabetic patients. So while it usually takes hours or days to get a CGM through a pharmacy benefit, it can take up to several weeks to get a CGM through a medical benefit.
Prevalence of Diabetes: Although one might think that countries with the highest prevalence of diabetes would also make the greatest investments in diabetes devices, this is not the case. Of the 14 states where at least 12 percent of adults have diabetes, only 6 states (Arkansas, New Mexico, Indiana, Ohio, Texas, and West Virginia) are 1 under Medicaid CGM is offered to patients with type 2 and type 2 diabetes.
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Medicaid costs: Five of the 10 states with the highest Medicaid costs (totaling over $15 billion) do not cover CGM for patients with type 1 diabetes and those with type 2 diabetes. This approach is not cost-effective, as CGM accounts for only 1.1% of total diabetes costs, while the cost of treating complications and lost productivity (both of which can be reduced through widespread use of CGM) accounted for 73.1% of the total cost of diabetes %. In addition, the use of CGM has been shown to be cost-effective for diabetic patients.
We believe that all people with diabetes who receive state Medicaid health care should have access to CGM to improve day-to-day diabetes management, reduce health care costs for hospitalizations and long-term complications, and improve quality of life. All people with diabetes, whether they have type 1 or type 2 diabetes, can benefit from using an intermittent or real-time CGM.
We also believe that eligibility requirements for receiving CGM through Medicaid should ensure reasonable exit costs and minimal processing delays. Medicare recently changed its eligibility requirements to make continuous glucose monitoring (CGM) more affordable, but many Medicaid plans still require 3-4 blood glucose tests per day. Medicaid recipients with diabetes do not have any form of CGM coverage in Alabama, Arizona, Florida, Georgia, Hawaii, Kansas, New Jersey, and Washington, DC.
Expanding CGM coverage in California will help many people with type 1 diabetes gain access to this valuable device, but there are millions of people with type 2 diabetes who could also benefit from CGM. California and the 21 other states mentioned above should expand Medicaid CGM coverage to improve diabetes management for all people with diabetes. We would like to see more states advance the use of CGM in their Medicaid programs. diaTribe will continue to support access to CGM for people with diabetes. We may earn an affiliate commission when you purchase through a link on our site. Here’s how it works.
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Finding the best phone carrier is a great way to save money on your cell phone bill. In addition to providing reliable wireless service wherever you are, truly great phone carriers also set themselves apart by offering affordable plans with tons of benefits.
So which phone carriers offer a combination of reliable coverage and attractive price plans? It’s not just about finding the best cell phone plan — although that certainly helps. You should also check the network coverage in your area, including the available 5G networks around you.
Other aspects to consider when looking for the best phone carrier include customer service – your wireless provider should be able to do that
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