The FreeStyle Libre flash glucose monitoring system allows a person to measure their blood sugar level continually. Medicare will cover some costs of FreeStyle Libre under certain criteria.
An estimated 33% of Medicare enrollees had diabetes in 2016, according to the Kaiser Family Foundation.
This article discusses FreeStyle Libre and diabetes. It also looks at Medicare coverage, additional costs, and where to find Medicare-approved suppliers.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Diabetes is a medical condition that affects the body’s ability to use or make insulin. There are two main types: type 1 and type 2.
In people with type 1 diabetes, the body does not make sufficient insulin and needs external insulin administration.
Type 2 diabetes means that the body cannot effectively use insulin to manage blood sugar levels. As a result, a person may need insulin injections or medications to improve their body’s ability to use insulin.
Monitoring and maintaining blood sugar levels is vital to a person’s health when they have diabetes. Medicare covers a variety of diabetes medications, testing supplies, and diabetes-related medical visits to help a person manage this condition.
FreeStyle Libre is a continuous glucose monitoring (CGM) system that allows a person to check their blood sugar in real-time without having to prick their finger.
The system has two components: a glucose sensor that the person applies to the skin and a digital reader. A person can apply the sensor to the back of their upper arm and leave it in place for a maximum of 14 days.
The sensor monitors a person’s blood glucose by measuring glucose levels in the interstitial fluid, which is the fluid between the cells and the blood vessels. A person can hold the digital reader over the sensor to obtain a blood glucose reading.
What other CGMs or insulin pumps does Medicare cover?
Medicare also covers the Dexcom G5 CGM, which is another continuous glucose monitoring system.
The Dexcom G5 and FreeStyle Libre are different than insulin pumps, which can monitor and administer insulin. Medicare also covers some types of insulin pumps. A person can talk to their doctor about what monitoring approach may be best for them.
The federally funded health insurance program called Medicare includes:
- Part A, which offers hospital insurance coverage
- Part B, which provides coverage for medical insurance
- Part C, also known as Medicare Advantage, which offers an alternative to original Medicare (Part A and Part B)
- Part D, which offers prescription drug coverage
Medicare considers designated blood glucose monitoring systems, such as FreeStyle Libre, to be durable medical equipment (DME). Therefore, Medicare Part B will help pay for a portion of the costs.
However, some qualifying requirements apply, including:
- A doctor must certify that the monitor is medically necessary and prescribe it.
- Both the prescribing physician and the supplier must accept Medicare assignment.
- A person must test their blood sugar levels at least four times a day and use insulin injections at least three times daily.
Medicare Part D will cover the costs of insulin that a person administers as a result of their FreeStyle Libre readings.
However, if a person uses an insulin pump, Medicare Part B typically covers their insulin. A person cannot have both an insulin pump and the FreeStyle Libre system under their Medicare coverage.
Current status of in-person meetings with a doctor
Before the COVID-19 pandemic, an individual had to attend several in-person meetings with their doctor. Within 6 months of ordering FreeStyle Libre, they had to have an in-person meeting with their doctor to discuss their blood sugar control.
To assess the treatment’s effectiveness, a person was also required to meet with their doctor every 6 months after starting to use FreeStyle Libre.
However, Medicare has temporarily expanded its telehealth service, which allows a person to have a virtual visit with their doctor without leaving home or having to go to a hospital or a doctor’s office. Available services include virtual check-ins and online patient portals. Medicare may pay for such medical visits.
Different parts of Medicare will provide coverage for FreeStyle Libre. However, a person may have additional out-of-pocket costs, and they will also have to pay for replacement sensors.
Costs for FreeStyle Libre vary, and a person may wish to check prices from various Medicare-approved suppliers using this information. According to the manufacturers, a person with private insurance will pay a monthly average of between $10 and $75 for two FreeStyle Libre 14-day sensors.
Although Medicare Part B may cover some FreeStyle Libre costs, a person might still be responsible for out-of-pocket costs. For example, they must first meet their Part B deductible, which is $203 in 2021.
After meeting the deductible, a person then pays 20% of the Medicare-approved amount for their FreeStyle Libre. Reimbursement rates may vary by year.
If a person has a Medicare supplement insurance plan, also known as Medigap, the plan may help cover their out-of-pocket costs.
A Medicare Advantage plan will provide coverage for FreeStyle Libre, although a person may have to pay the 20% Part B copay.
Help with costs
If a person needs help paying the Part B copay, they may get support through Medicaid, a state and federally funded program that provides medical financial assistance.
Abbott, the company that makes FreeStyle Libre, also have a patient assistance foundation that helps people in financial need. Assistance may include a free meter, battery replacements, and sensors, depending on a person’s individual needs.
A person must obtain the FreeStyle Libre from a Medicare-approved provider. Not all sellers of DME will provide this system.
A person can check for DME suppliers on this list, which gives the details of Medicare-approved suppliers, including their name, website, and phone number.
Medicare may cover the FreeStyle Libre as a means to help manage type 1 or type 2 diabetes, although a person must meet certain criteria. A person who frequently monitors their blood sugar and administers insulin may qualify for Freestyle Libre, which requires a doctor’s prescription.