North Carolina Medicare CGM Coverage: Tar Heel State Guide

If you’re a Medicare beneficiary living in North Carolina who needs a continuous glucose monitor (CGM), understanding your coverage options is essential. This comprehensive guide will walk you through everything you need to know about Medicare CGM coverage in the Tar Heel State.

Quick Guide to North Carolina Medicare CGM Coverage

• Medicare covers CGMs for qualifying beneficiaries in North Carolina
• Both Original Medicare and Medicare Advantage plans provide coverage
• You must meet specific eligibility criteria
• Coverage is available through Medicare Part B as durable medical equipment (DME)

Medicare CGM Coverage Requirements in North Carolina

To qualify for CGM coverage in North Carolina, you must meet Medicare’s standard eligibility criteria:

• Have diabetes (Type 1 or Type 2)
• Test blood sugar 4+ times daily
• Take insulin with at least 3 daily injections
• Adjust insulin doses based on testing results
• Have a face-to-face visit with your healthcare provider within 6 months of ordering the CGM

Covered CGM Devices in North Carolina

Medicare covers these therapeutic CGM systems in North Carolina:

• Dexcom G6
• Dexcom G7
• FreeStyle Libre 2
• FreeStyle Libre 3

Cost Sharing for CGMs in North Carolina

Under Original Medicare Part B:

• You pay 20% of the Medicare-approved amount
• Your Part B deductible applies ($240 in 2024)
• Medicare covers 80% of approved costs

Finding CGM Suppliers in North Carolina

To get your CGM covered, you must use a Medicare-enrolled supplier. Major DME suppliers in North Carolina include:

• Local pharmacies (CVS, Walgreens, etc.)
• Mail-order suppliers
• Medical equipment companies

North Carolina Medicare Advantage and CGMs

Medicare Advantage plans in North Carolina must provide at least the same coverage as Original Medicare, but many offer additional benefits:

• Lower copayments
• Reduced deductibles
• Additional CGM device options
• Enhanced diabetes management programs

Step-by-Step Guide to Getting Your CGM Covered

1. Consult Your Doctor
   • Schedule a face-to-face visit
   • Discuss CGM options
   • Confirm you meet coverage criteria
2. Get Documentation
   • Obtain prescription
   • Ensure proper medical documentation
   • Get Statement of Medical Necessity
3. Find a Supplier
   • Locate Medicare-enrolled supplier
   • Verify they accept assignment
   • Check if they’re in-network (for Medicare Advantage)
4. Submit Documentation
   • Provide all required paperwork
   • Include prescription and medical records
   • Submit any additional forms needed

North Carolina Diabetes Resources

Additional support is available through:

• NC Diabetes Education Recognition Program
• Seniors’ Health Insurance Information Program (SHIIP)
• North Carolina Diabetes Advisory Council
• Local diabetes education programs

Common Coverage Challenges and Solutions

Challenge 1: Denial of Coverage

Solution: Ensure all documentation is complete and accurate. Appeal if necessary with support from your healthcare provider.

Challenge 2: Finding Suppliers

Solution: Use Medicare’s supplier directory or contact our support team at 888-649-5705 for assistance.

Challenge 3: Understanding Costs

Solution: Review your plan benefits and speak with a Medicare counselor about supplemental coverage options.

Supplemental Coverage Options

Consider these options to help with out-of-pocket costs:

• Medigap plans
• North Carolina State Health Insurance Assistance Program
• Medicare Extra Help program
• Medicaid dual eligibility

Conclusion

Understanding your Medicare CGM coverage in North Carolina doesn’t have to be overwhelming. With the right information and support, you can access the diabetes management tools you need. Our team at Senior CGM Support is here to help you navigate the process.