Dexcom and Medicare

Diabetes Technology Glucose Monitoring
1

Hi everyone,
I am curious to hear from those of you who have reached the magic age of Medicare. It is my understanding that Medicare does not cover CGM supplies and am wondering if any of you have discovered any resources to get around this. I am going on Medicare next Spring. I have been fortunate to have really good (and expensive) insurance that has paid for it all - CGM, Pump and supplies! So now I am facing Medicare shock!
Thanks in advance,

2

Dexcom will give you a break off list price if you are uninsured. Also, if you purchase a whole bunch of sensors over a defined period of time (which you'll need anyway), they'll give you a free transmitter (a $600 value) -- but don't expect them to automatically tell you of that promotion. I just verified that this promotion is still alive when I called them a day ago.

3

Thanks Bill! This is good to know. I will certainly ask about it when my time comes in May'15.

4

I must admit that I am worried about the same thing. I am 73 but still working so not yet on Part B Medicare. I am hoping that one of the Advantage plans will work but I haven't checked yet.

5

I have a Medicare advantage plan through United Health Care. So far, I have been getting my supplies covered with no co-pay. I don’t really understand the difference between advantage plans and supplement plans. Maybe not everybody is eligible for an advantage plan. Somehow, this is connected to my employer before I retired.

6

It has been a year since your post. But the issue is still relevant.
Has Medicare covered your Dexcom Transmitter and Dexcom infusion supplies?
I am on Medicare, planning to use DexCom’s CGM. I called my insurer, Blue Cross/Blue shield, and was informed that the Transmitter would be covered under Durable Medical Equipment and the infusion supplies would be covered under Diabetic supplies. But, the only way to be sure is to have my Endo submit a Prior Authorization to Blue Cross/Blue shield. I am seeing my Endo 12/30.

I did find remarks that Medicare cannot deny coverage for CGM.
See You tube


CMSHHSgov
The Video not of relevance, provides general info on Medicare.
In the comments section, Dan Kraft stated that “May 26, 2015 Federal Court rules Medicare cannot deny coverage for CGM”. There are links that provide more detail.

7

Hi Rann,
MediCare has denied my DexCom supplies and because of their denial - my supplement insurance (Blue Shield) has also denied. I have been told by DexCom that my only option at this time is pay for the supplies myself. They did tell me about their “special offer” for non-insured patients - which is a help, but still quite expensive on a monthly basis…
If you (or anyone else), have a different experience - please post it here!
Thanks, '
Metheniac

8

I have come up against the same issue: If Medicare doesn’t cover CGM sensors then the insurers won’t either, in my case US Healthcare. I am interested in the following:

  1. KCaHubby_Dave, you mentioned that Dexom sensors is covered by UHC Medicare advantage plan you are on. Are you retired and all sensor cost is paid by UHC? What is the name of the plan you’re on, so I can join it next December?
  2. Because Dexcom sensors are not covered on any standard insurance plans (including Plan F), has anyone found another country where you can buy sensors at a discount. I’m thinking that, in the same way retired Americans can buy some drugs cheaper in Canada, is there a country that has lower sensor prices? If anyone has found a place to buy discounted sensors, other than the deal through Dexcom, I’d appreciate knowing. Paying $89 each is just too expensive, even if the $600 transmitter comes free.
9

I am retired. The plan I am on is AARP MedicareComplete Choice Plan 2. It is through United Health Care.

10

I spoke with someone at AARP MedicareComplete Choice Plan 2 about Continuous Glucose Monitor coverage under Medicare durable equipment Part B. They told me that if Medicare does not have it on their approved list, I need to have my doctor call the Medicare provider line and say that CGM is necessary for my diabetic control, particularly since I am on an insulin pump. Would UHC make an exception to cover this? If approved, I was told that I would pay 20% of UHC’s cost of the CGM. I was also told that, in general, exceptions can be made. You are on a Dexcom, and is this how you got it approved?

Thanks for your help,

11

I was already on the Dexcom when I went on Medicare so it seems my coverage just continued. I don’t ask questions because I am always worried they will find a reason to discontinue coverage. Insurance companies are more concerned with their profit than our health.

1 Like
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Truer words were never spoken!