I agree with you, John. Usually when we talk about pump and/or CGM Medicare coverage, we either talk about Part B DME coverage with traditional Medicare and a supplemental policy (medigap) or we refer to a Part D Prescription plan. Most of us do not have the premium Part D coverage like retired NY govt. works like @andrea8. What she may have referred to as a “supplement” policy may have been her former employer’s supplement to her Part D Rx insurance that left her with no or minimal out of pocket cost.
From all this bureaucratic minutia I have concluded that Twiist is covered by the pharmacy channel and will never be covered by Part B DME. It’s too bad for me but at least I have access to a great AID system that is affordable. And Eversense 365 is covered by Medicare Part B!
That’s only part of the Empire plan. The 2026 plan document is very confusing because it covers all the options for people who are currently working and for “retirees”. People obtaining coverage through NYSHIP (New York State Health Insurance Plan) have to sign up for an HMO. Normally there is a choice but for people on Medicare there seems to be only one plan available in each county; that plan is apparently a Medicare Advantage plan and, given that this is an HMO, I assume it is an MA-PD plan providing “prescription drug coverage”, so no Part D.
Part D is irrelevant to this discussion; the Empire document clearly documents Medigap-like coverage (where Empire pays “80%” of the bill after the deductibles), but it may not be true Medigap. If it is true medigap it is one of the variants with its own deductible, variants of G available state-by-state, or with an out-of-pocket (K or L).
The fact offered is this: @andrea8 has twiist covered under Part B+Medigap. Lots of details have been provided. The Medigap is provided by Empire, Empire does provide something that looks darned like medigap from its own policy documents. Medigap (unlike Part C) does not get involved in coverage decisions. QED.
It wouldn’t be covered under Medicare because of the CMS rules:
There are various gotchas in there including, but not limited to:
o The beneficiary’s treating practitioner has concluded that the beneficiary (or beneficiary’s caregiver) has sufficient training using the CGM prescribed as evidenced by providing a prescription; and,
o The CGM is prescribed in accordance with its FDA indications for use; and,
Etc, etc. The EverSense is, so far as I can determine, also not available on a prescription. Rather it is provided directly to the medical provider. The person who reported getting an EverSense here (or maybe it was TuD) reported that the endo did the implant. Since all doctors are surgeons any doctor could do it but, surely, the endo would do it?
The issue seems to come down to getting an endo who wants to do it. It also seems that the procedure, while simple, has specific training; the doc will need to pay for that. The more practical approach of DIY runs into the problem that getting the sensor will be very difficult.
@jbowler There was a bit of sarcasm mixed with truth. My endo asked me if if was interested in Eversense, so I assumed he would do it or refer to a general surgeon.
EverSense has reared it’s implantable head. My original post was not intended to be specific to Dexcom and, indeed, while Dan Heller seemed to obsess a lot about Dexcom and their curiously unused patents, I don’t think Dan’s has to be take that way either.
Part of what I was trying to say is that CGMs, all CGMs, are unreliable but, as @John58 pointed out, algorithms like the Loop “micro bolus” approach to BG corrections are already in place to handle this damaged data. @John58 posted data that mirrors my own, Dan Heller’s “Jane” data was more extreme and, while I have observed instances of that issue as well, it seems to be much less common. Or maybe those of us who encounter it die, I don’t know!
So EverSense; is it accurate. What about Abbott’s various offerings; I’ve seen much assertion that Abbott is highly inaccurate but I don’t find such assertions credible. I can see that the Dexcom is “highly inaccurate” too, for many of us. So what?
The big deal about the EverSense is that it is a 365 day commitment. At this point, given that xDrip+ has support and my endo didn’t like my suggestion of Libre3+ I’m inclined to go for it; if I want to take a risk I want to take one that brings a big benefit. I consider my continuing use of the 10-day G7 a risk; maybe a manageable one (I accept the point about the Loop micro-bolus algorithm) but maybe the EverSense is better?
Not suer why you pose incorrect and speculative information so much about products you have not researched. The Eversense is Rx only, only qualified medical professional who have completed the Eversense insertion training and are approved can do insertions. Medicare does cover the procedure. The best source for real and accurate information is from Senseonics at https://www.eversensecgm.com. You will be contacted by a local rep.
The point I was making is that it is not an extremely complicated procedure to insert an Eversense sensor. The company probably requires training for safety and liability reasons.
This may put off some doctors who are busy enough without doing the training.
I could be wrong but my doctors seem to be running all the time.
I see my endo early May. If I remember I will ask him about Eversense training.
Personally I am not interested in it. Not the insertion but then comes removal and replacement.
Senseonics will not provide the product to anyone not authorized and trained, period. The insertion uses tools specific for the product and can easily be inserted incorrectly. If a provide who is not authorized inserts the sensor the warranty is voided, and frankly the patient may not be protected from any negative outcomes.
I tried the 90 day sensor many years ago. You raise a valid point about the removal and replacement… the procedure leaves a scar about the size of a raisin in ones arm. I don’t care too much about that myself, but suspect that younger people would be wary of continued scarring and would opt out after the first sensor. I wonder how many long term users Senseonics will keep after the first few years.
Side note about the insertion: You’ve got a fairly deep incision susceptible to infection until it heals over. A minor 7-10 day hassle every 365 days. Unless it gets infected in which case you’re removing and replacing, again, hopefully the doctor is local and available.
I appreciate the comments about the negative aspects of the Eversense (scarring, potential infection, 7-10 day healing time, one location for the receiver for a a year (hadn’t thought about that much),etc. I’d like to hear the positives from those that know/use as well, like the one year period (is it a hard limit or is there extended period potential), potential for longer wear (would reduce the number of scars/procedures/etc.), compatibility with pumps and AIDs, etc.
Thanks for that, @JBowler. It IS of great interest to me and I have been chatting with Dan a bit about this online in another forum. Thanks for posting this conversation topic and getting everybody to join it. It’s a great topic.
Lots of questions here. So far as I can remember we’ve never had an Eversense user commenting about performance in the way that there are continuous and multiple threads about Dexcom accuracy, and, most common, failures. The same applies to the Abbott sensors, maybe there are some European BBs with that kind of discussion but I don’t know of any.
How often do you do fingersticks (i.e. how often do you calibrate)?
What are the first two weeks like (where more frequently calibration is used)?
Do you experience drop-outs/spasms as I and other people do with the Dexcom sensors? (BTW I don’t know if these happen with Abbott’s sensors.)
What is the accuracy? Since you have to calibrate at least every week what is the divergence from the fingerstick when you calibrate?
What is the delay from the fingerstick reading? Dexcom sensors seem to delay around 5 minutes for the “raw” (unsmoothed) readings but smoothing typically adds significantly to that.
Do you know if EverSense smooths, and are the “raw” readings available?
Do you see systematic errors; where the CGM drifts over time so that it starts out fine but then ends up off by a fixed amount.
Do you see random errors; the type Dan Heller was complaining about.
Do you use an AIDS? (Twiist, AAPS, etc) and how well does that work with respect. Not easy to answer of course; results are personal and time dependent, a direct comparison (using two AIDS at once) is impossible.
What a strange thing to say. I don’t think anyone here is purposefully trying to put out conjecture, myths, or false information. This group is highly capable of having clear, educated conversation and debate and members seem open to correction if they are mistaken.
How long have you had the Eversense? I am interested in hearing about your experience, especially the placement of adhesive in the same spot for a year straight. Thanks - Jessica
Oh, Ok, I’d hoped for a few months. However you are down to 1-per-week I think on the calibrations and I’m guessing you have changed the adhesive (I can’t remember how often that happens), so what has happened?
There is a specific calibration regiming that is use during the first day, four days and there after. I have saved so many strips in that time it is amazing.
The readings take about two weeks to stabilize. After that the are extremely consistent.
I never experienced so call dropouts with the Dexcom G7, unless I did not use or connect is correctly and avoided phone sessings and apps that interrupt the hand shake of data betweek the device connected, phone or pump. This is something so many do not udeerstand about using the bluetooth connecteds CGM. Rarely is the drop a product issue.
Well within 20%, more like <10% on what I have experienced, timing and rate of change has a big impact.
This is a loaded question, It, like all CGMs is measuring intersticial fluid and the delay if a reading is the same, the arrows are key info like many other CGMs and is directly impacted by hydration, location, activity, health, time of day , etc. But the 365 is much better than any CGM I have use in the last 20 years. .
Yes. the graph is smoothed, but the readings are used every 5 min by the pump.
Nope
No random unexplained errors that I have experienced, or the other user I know.
The Twiist pump is the only AID puup that uses the Twiist. DIY is in process.
So that’s a big deal for many of us; after all many people complain about the stabilization time of the Dexcom sensors which is somewhere in the range 2-36 hours. Two weeks is reasonable for a sensor that lasts 52 weeks IMO; it means 4% of the useful time is lost. For me with the G7 I lose around 8 hours (stabilization time is clearly per-person) and that’s maybe 3% of the useful time for me. I’d like better of course, particularly as I can’t get the test strips on Medicare with the G7 whereas I certainly can with the Eversense (since calibration is required, unlike the G7).
I didn’t mean connectivity dropouts; I was referring to sensor “dropouts”. I switched to the terms spasm/spastic to avoid that confusion, I was referring to the spasms in, for example, @John58 's screenshot above, which show two sudden drops but three sudden rises. All of these have the potential to interfere with AIDS performance.
[Accuracy:]
Same as my experience over several years with the Dexcom sensors; for example my most recent fingerstick (not paid for by Medicare) shows readings of 192 then 188mg/dL with a fingerstick mid way between (xDrip+'s assumed delay included) of 198mg/dL; off by 4%.
Part of the reason I posted Dan Heller’s article originally; I was quoting unsmoothed readings above but I don’t know the internal averaging done by the CGM. I don’t think anyone does. The delay could be very large. That’s one thing that I think Dan Heller’s article misses; noise does not matter than much if the smoothing is enough to remove it, but the smoothing imposes a delay because it is done using readings from the past. That introduces an extra delay which may be significant for an AIDS; @john58 's point about the micro-bolus algorithm which handles such errors, but then my point that this introduces a delay which critically impacts corrections.
It’s reasonable to wait a couple of months at the very least for the answers about “systematic” (I meant systemic) errors and, for that matter, random errors. I’m less concerned about random errors; again @John58 's micro-bolus point. Systemic errors have been the bane of my control for the last few Dexcom sensors I’ve used but for the most recent two they have gone.
One advantage of more frequent sensor changes is that systemic errors have an easier recovery; going into surgery to replace an errant Eversense after 11 months is a bigger deal.
My understanding is that DIY is done. I haven’t tried it but Eversense support is there in xDrip+. What I’ve read is that while it might be less convenient to set up than the built-in support for the Dexcom sensors it’s not that big a deal. Of course I’d do more research before trying it!
I’ll probably stick with the G7-10 ATM; better the devil I know. However it’s on my discussion list for my next endo appointment and, given that a resupply of G7s won’t last me much until the appointment 3 months after the next one Eversense is certainly going to be a consideration then.
One of the issues, if my endo supports it (i.e. will do the surgery) is whether I can get the overlap; the Medicare billing is one code for removal of the old sensor and insertion of the new one. That would probably be a show-stopper for me, given the 2 week stabilization. But I don’t see why my endo wouldn’t be happy to do an insertion then, some time later, the removal. In fact given that I wander around with two G7s attached to me on the change-over I don’t see why I couldn’t wander around with two Eversenses, doing a soak-in on the second. Maybe even delay the removal for the 3 months between my pump appointments.
Thanks for that,