Yes, any vendor selling Dexcom and Omnipod should be able to handle this. I checked and my Dexcom vendor, Minipharmacy, sells both. However I do not have any real life experience with Medicare and a Part D plan and Medicaid so I don’t know if there is an advantage to using two different companies. Since Medicaid is different in each state consider saying what state you are in.
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I have Aetna Silverscript Part D for pods and then plain old Part B. But I have QMB which pays the rest of expenses and runs through the Medicaid program. It’s managed by the state but you apply through Social Security. “Qualified Medicare Beneficiary”. They toss you off normal Medicaid once you turn 65. .
Now my orders are processing. Let’s see if they actually call me to let me know when theyre ready…
UPDATE: I dropped the account. They never ever called and yet moved my order into yet another layer for processing, stating they needed more still from my doctor. I called Solera (Adapt) and though I have had minor issues since Diabetes Management went and merged, they got my pod order set up and my Dex supplies. In about half an hour. Maybe Community is good in some cities but this was the most dreadful service. Too bad too, because it’s more like local economy.
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I was never successful with my pharmacy handling this-total disaster. My DME provider, US Med, does well with this process. There are many other good DME providers.
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I got my Dex at Kroger grocery store pharmacy with no issues. After I went to Medicare in October, they just couldn’t handle that anymore. But that was always flawless ordering.
Walgreens is the pharmacy that messed up everything for me in 2018. They still owe me $88 because they would not give me my supplies without me paying them my Medigap portion. Then of course my supplement paid them $88. Multiple calls to corporate without success. What a joke!! There is such an easier way. Quit wasting your time.
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I tried Walgreens. Pharmacist seemed to know what he was doing. He said it has to go through Walgreens Medicare department. Three weeks went by with no movement. I gave up and called dexcom for the a recommended supplier because I had horrible experience with EdgePark when I had commercial insurance. They recommended Pinnacle Medical. Which is now in the process of merging with Adapt Health/ Solara. The service has been wonderful since day 1 and I’m going on three years now. Ditch the pharmacy.
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Yep. I see today they were trying to get me a receiver, which I didn’t need and the dr didn’t order. I have one already to fulfill the DME requirement. I got a new provider/supplier and it only took half an hour.
I was getting classic pods at Adapt. They wouldn’t take my Medicaid for Omnipod 5 but when I informed them I was now on Aetna Part D and needed pods, they filled it right away. Or at least set it up for my next refill. They got the sensors and transmitter ordered in the same call with one phone transfer. Much more pleasant.
I am glad that you are on the right track now.
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You also asked if Medicare covers glucose test strips. They do, but there are quantity limits. I am able to get 300 strips and 300 lancets for a 90 day period, covered by Medicare (I am T1D, have a CGM and a pump). I also believe Medicare does not cover strips and lancets in all 50 states. Your CDE may be able to tell you whether strips and lancets are covered by Medicare in your state as she likely writes scripts for them. Medicare should also be able to answer that question if you call them.
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Oh thanks for that info! I’ll ask her.
There have been a couple of people that have said they have gotten test strips while having a CGM on Medicare. But Medicare doesn’t actually allow it. If you are getting it, never rock that boat! All of us would love to know how though!
UPDATE My doctor got test strips okayed through Part D with no issues. 100 per month supply. They said it depends on how it’s requested.
Supposedly once you have a non adjunctive CGM, you will be denied test strips. If you have an adjunctive CGM I guess you could get test strips, but there is no approved adjunctive CGM in the US.
I’ve included the pertinent link.
Scroll down to the Blood Glucose and CGM sections. The part about not covering test strips is almost to the end of the section under CGM’s.
@Laura_S Are you on Eros Omnipods or Omnipod 5? You mentioned both. I’m sure you know but the Eros pods are being discontinued I think at the end of the year. You have to switch to Dash or Omnipod 5.
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I also find they ask me in a timely fashion if I’m ready for my next order. Via text. I say yes and then answer a few questions that are required by Medicare and I get the supplies a week later. Never been late. They also have an app where you can place your order and track the progress of it. Far superior to any other supplier I’ve dealt with, either a a patient or a CDCES for 20 years.
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I have a stash of Eros (and two more PDM’s that a rep gave me, brand new) but started now ordering the 5’s and trying to think of a good time to try them. I don’t like rechargeable batteries and will miss my Freestyle meter, though I could keep using that stand aline. I also get 70 strips for my other meter for $30 from Amazon if I need to. I will still find out what the CDE says about strips.
Yep I have the app now too. And never had an issue getting notified for refills of my pods. I was using Diabetes Management and Supply which is
Adapt now.
I have the LCD that you referenced and for which you shared the link. Medicare is extremely complicated and confusing. I am definitely not an expert on Medicare rules. That LCD appears to be effective for certain U.S. states and territories (those states & territories are listed on the LCD).
Here's some info on LCDs that adds context: **LCDs are decisions made by a Medicare Administrative Contractor (MAC) whether to cover a particular item or service in a MAC’s jurisdiction (region)** in accordance with section 1862(a)(1)(A) of the Social Security Act. MACs are Medicare contractors that develop LCDs and process Medicare claims. The MAC’s decision is based on whether the service or item is considered reasonable and necessary."
Based on the referenced LCD, it seems that Medicare does not offer the same coverage, ie test strips and lancets, for subscribers in all 50 states or territories. I'm in WI and Medicare does allow and cover test strips and lancets; Medicare states quantity limits on the items. (I was using a WI Walmart pharmacy for a while and they requested my testing logs to be able to provide to Medicare to prove that I needed and was using, test strips.)
I have seen other posts on this forum from other Medicare subscribers who were unable to have test strips covered by Medicare and after reading the referenced LCD, my opinion is that Medicare does not cover the same items in all 50 states: coverage depends on where you live. If anyone else has any experience or detailed information on this, it'd be enlightening for all of us who are Medicare subscribers.
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John does Medicare part B cover the full cost of the Dexcom G7?
Medicare Part B covers 80% of Dexcom G7. To be covered 100%, you additionally need Medex or another Medigap supplement plan.
Thank you, Does it pencil out better to pay the 20% or get a Medigap policy?
Marguerite Truttman
The Medigap is a no-brainer for me because the 20% for Dexcom goes a long way toward covering the premium. Additionally, Medicap covers all of my other copays, and I can get treated by any entity that accepts Medicare, so I can choose the best hospital(s)/doctor(s) for any issue I may have anywhere. I also don’t need to use in-network doctors. There are a few different plans, so you just need to choose what works best for you.
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