Texas Medicare CGM Coverage: Everything Lone Star Seniors Should Know

For Texas seniors living with diabetes, continuous glucose monitoring (CGM) systems can be life-changing devices. But understanding Medicare coverage for CGMs in the Lone Star State doesn’t have to be complicated. This comprehensive guide will walk you through everything you need to know about getting your CGM covered by Medicare in Texas.

Quick Facts About Texas Medicare CGM Coverage

• Medicare Part B covers therapeutic CGMs for eligible beneficiaries in Texas
• You’ll typically pay 20% of the Medicare-approved amount after meeting your Part B deductible
• Your doctor must document that you meet Medicare’s coverage criteria
• Texas Medicaid may provide additional coverage for dual-eligible beneficiaries

Medicare CGM Coverage Requirements in Texas

To qualify for CGM coverage under Medicare in Texas, you must meet these specific criteria:

• Have diabetes (Type 1 or Type 2)
• Test your blood sugar 4+ times daily
• Use insulin at least 3 times daily OR use an insulin pump
• Regularly adjust your insulin dosing based on testing results
• Have an in-person visit with your healthcare provider within 6 months of ordering the CGM

Covered CGM Systems in Texas

Medicare covers these therapeutic CGM systems in Texas:

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

Texas Medicare CGM Costs

Here’s what you can expect to pay for your CGM in Texas:

With Original Medicare:

• 20% of Medicare-approved amount for the CGM device
• 20% for sensors and supplies
• Annual Part B deductible applies ($240 in 2024)

With Medicare Advantage:

• Costs vary by plan but cannot exceed Original Medicare
• Some Texas Medicare Advantage plans may offer lower copays
• Check your specific plan’s coverage details

Getting Started with CGM Coverage in Texas

Follow these steps to obtain your covered CGM:

1. Schedule a Doctor’s Visit
   • Make an appointment with your healthcare provider
   • Ensure visit is documented as diabetes management
   • Discuss CGM options and benefits
2. Document Eligibility
   • Provide blood sugar testing records
   • Document insulin usage
   • Confirm Medicare coverage criteria are met
3. Get Prescription
   • Obtain detailed prescription for CGM system
   • Include all necessary supplies
   • Ensure proper documentation for Medicare
4. Choose Supplier
   • Select Medicare-enrolled DME supplier
   • Verify they accept assignment
   • Confirm they can bill Medicare directly

Texas-Specific Resources

These local resources can help Texas seniors navigate CGM coverage:

• Texas Health Information, Counseling and Advocacy Program (HICAP): 800-252-9240
• Area Agency on Aging: 800-252-9240
• Texas Medicare Administrative Contractor (MAC): Novitas Solutions

Additional Coverage Options in Texas

Medicare Supplement (Medigap) Plans

A Medigap plan can help cover your 20% CGM coinsurance. Texas offers all standardized Medigap plans, which can significantly reduce your out-of-pocket costs.

Dual Eligible Coverage

If you qualify for both Medicare and Texas Medicaid, you may have additional coverage benefits and lower costs for your CGM.

Common Questions About Texas Medicare CGM Coverage

Q: Can I keep my current CGM supplier when switching to Medicare?

A: Yes, if they’re a Medicare-enrolled supplier. If not, you’ll need to switch to a Medicare-approved supplier.

Q: How often can I get new sensors in Texas?

A: Medicare covers:

• Dexcom sensors: Every 30 days
• Freestyle Libre sensors: Every 28-30 days
• Transmitters: Every 90 days (Dexcom)

Q: What if my claim is denied?

You have the right to appeal Medicare decisions. Contact Texas HICAP for free assistance with appeals.

Tips for Texas Seniors

• Keep detailed records of all diabetes-related medical visits
• Maintain a log of daily blood sugar tests and insulin use
• Work with Medicare-enrolled suppliers who accept assignment
• Review your Medicare plan annually during Open Enrollment
• Consider a Medigap plan to reduce out-of-pocket costs

Conclusion

Understanding your Texas Medicare CGM coverage doesn’t have to be overwhelming. With the right information and support, you can successfully navigate the coverage process and get the diabetes management tools you need.

Need help confirming your CGM coverage? Our team of Medicare specialists is here to assist you:

• 📞 Call us at 888-649-5705
• ✓ Use our online Coverage Checker tool
• 📥 Download our free Texas Medicare CGM Guide

Don’t wait to get the diabetes care you deserve. Contact Senior CGM Support today to verify your coverage and start your CGM journey.