Dexcom G5 and Medicare

Has anyone on this Forum used Medicare or Humana Medicare Advantage Plan to get the Dexcom G5 CGM. I am trying to get the G5 using Humana Plan and so far things are not going very well for me. Can anyone comment on this issue?

i have medicare but i have a different medicare part d (i think) plan. i had to write a medical of necessity letter to show that it would be a benefit for me to keep my levels down so i dont end up in the hospital. if you work with a medical supplier they can help you through the process and help you get it covered

Medicare and United Healthcare (AARP). Got my G5 w/o issue, for free.

Amy and Dave it sound like you both have Medicare as your primary and are using supplemental plans… I have Humana Medicare Advantage Plan. I went directly to Dexcom to start my process, but when I called them back they blamed negotiations between them and Humana was holding up the process… I was looking for someone who uses Humana, which is my Medicare Provider and should follow Medicare rules and guidelines I have no clue why Dexcom would need an agreement with Humana for Medicare members.

Bob, I’m aware your issue is with Humana. I mentioned what insurance in have in case you decide to change yours. good luck!

https://www.dexcom.com/faq/medicare

Dexcom
August 28, 2017
"Please note that at this time, we are not able to process Medicare Advantage plans."

I do have medicare. i use to be a medical biller as well :)…and of course had trouble with insurance working out. with the medicare suppliment plans they are pretty much the same except what is on their formiltry (sp).

Hey Tim thanks for the URL. I had missed this, I was told by Dexcom in my first called that it would be slow going, but I wasn’t told that only Medicare Advantage Plan were being held up, which I don’t understand since these plans follow Medicare guidelines…

Also, thanks Dave for the heads up on difference Advantage Plans, but I am stuck with Humana because of my insurance coverage prior to Medicare coverage. I am locked in to Humana.

All I know is that my Humana Plan covers my Part A and Part B, Prescription Program and 20% supplement needs not cover by Part B. So I am not sure why Humana or whoever is holding up diabetic medicare members G5 Processing.

@Bob_Martin
Hopefully it is only a matter of getting contracts in proper order which unfortunately always take far more time than seems even remotely reasonable. As opposed to there being a “dead in the water” type of issue.

Best way to slow anything up is to throw a few lawyers at a problem. I imagine these sorts of contracts get a whole room of lawyers.

On the plus side - by the time they are finished - it should be all good. I guess that is the upside of lawyers - their end product/contract is usually rock solid.

We are just now going into the “Open Enrollment” period where you can change your coverage. I have been with 3 different “Advantage” plans since going on Medicare in 2013 and each one had issues, Dr. not in network, co-pays, exclusions. I changed to Part A & B with AARP Supplemental and though I pay $135 a month for the Medigap and Part D, at least I don’t pay $700 co-pay for insulin every 3 months and it was easy to get Dexcom G-5.

did you get your G5 with Humana Medicare Advantage yet? I am new here

Sorry to say, but the answer to your question is NO. Dexcom claims that
they in contract negotiations with the Medicare Advantage Plans, but as the
kids are saying, I say BS. When I talk to Humana about this BS they tell me
that they are not aware of any negotiations going on with Dexcom and all
Dexcom needs to do is process the ordered to them following Medicare’s
guidelines for the G5 system. I know Dexcom and Humana have a relationship
because for to years Humana paid for my G4 until they realized it was not
covered under Medicare and pulled the plug. I am currently using the G4 and
paying out-of-pocket.

I did send Dexcom a nasty note to voice my concern about this mess and told
them I was giving some serious looks at the FreeStyle Libre system, which is
now covered by Medicare. If anyone on the forum knows more about this
matter I would enjoy hearing about it.

Thanks,

Bob.

Bob, you posted orginally back in Oct, 2017. Have you given any thought to just changing your Humana plan for another one that actually works with Dexcom? Seems like you are fighting city hall, and we all know how that turns out.

Hey Dave thanks for the input. Dexcom tells me that none of the Medicare
Advantage Plans members are being processed right now, only the original
Medicare members. Do you know something I don’t know? I am locked in with
Humana and can’t change to another Plan. Keep those cards and letters
coming, lol.

Bob

I doubt I know anything that you don’t. I was just wondering if you had thought about changing to a Supplemental plan (such as what I have). I guess you can’t change?

@Bob_Martin
The Dexcom website is sometimes outdated, but what they do have up currently does appear to be what @Dave44 is saying.
I use the word “appear” not to cast doubt on Dave’s statement but rather due to my complete ignorance with Medicare. I really find it all extremely confusing and hard to follow.

= = = = =

August 28, 2017
https://www.dexcom.com/faq/medicare

We are pleased to announce we’ve begun shipping the Dexcom G5® Continuous Glucose Monitoring (CGM) System to Medicare patients with traditional fee-for-service coverage. Please note that at this time, we are not able to process Medicare Advantage plans. We are continuously working to make this happen and will provide updates as more information becomes available. We certainly appreciate your ongoing patience as we continue working through our queue of Medicare orders in the order they were received.

= = = = =

However, I also see this link (below) which seems to indicate further progress is being made? Third party link reporting news so hopefully it did not get the details wrong:

January 12, 2018
http://www.mobihealthnews.com/content/unitedhealthcare-dexcom-launch-cgm-pilot-medicare-advantage-members

UnitedHealthcare and Dexcom announced today at CES in Las Vegas that they will collaborate on a pilot program to provide Dexcom CGMs to UnitedHealthcare Medicare Advantage plan participants.

@Tim35 My plan is UnitedHealthcare Medicare Supplement Plan F. Plan F seems to be the most popular version of a supplemental plan in the US.

dexcom isn’t your g5 supplier. not in-network. find humana’s in-network 3rd party DME supplier. prob ccs medical, byram, edgepark, solara, or advanced diabetes supply. tell doctor to find in network, and send them a PA authorization to ship.

dexcom profits when you pay full price cash
humana profits by denying claims
follow the money, keep records and do it in writing

Dave my plan with Humana is what they call an advantage plan it is a
combination of my Medicare and my secondary plan and covers 100% of my
medical needs after I meet the front end deductibles. It is a good plan if
I could get someone moving on the G5 mess.

Bob

Ann thanks for the information. I currently get my supplies covered by
Medicare from Solara, but when all this G5 stuff started I ask them if they
could process my G5 order and they told me that Dexcom was handling the
Medicare G5 coverage and processing and I had to go through them. Do you
know something that I don’t?

Bob