For folks that don’t have compatible phone for dexcom G7 app or Tandem pump (when updated), the G7 receiver is only option.
I prefer xDrip on Android as the best app for BG display, alerts, and flexibility. And in case of Tandem pump failure, I would still have Dexcom data.
I am on Medicare and get my Dexcom supplies through CCS Medical. When I asked CCS to upgrade me from the G6 to the G7, they told me Dexcom may request my G6 receiver returned. A few days later, I got a G7 upgrade kit from CCS with the sensors and a new receiver and have not received a request to return my G6 receiver. Since I use my Android phone and have never used the G6 receiver, I am unsure where I put it. When looking for it, I stumbled upon my G5 receiver, so who knows when the G6 receiver will even show up.
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I started getting G7 sensors from US Med a little over 3 months ago and received my second 90-day batch of sensors yesterday. I checked the Medicare website a few months ago and saw that US Med was receiving its payment 30 days at a time.
I do not have a G7 receiver and will request one from US Med in June, 2024, the five year anniversary of receiving the G6 receiver. I will use the iPhone app in the meantime.
Did you get prior G6 receiver covered by Medicare that requires 5 years? Or is that irrelevant?
I start MC next year with Tandem pump as receiver, that I’ve had 4 years. Wondering if MC imposes 5 year rule on DME purchased before start of MC??
My G6 receiver, acquired in 2019, was covered by Medicare. Perhaps someone else has experience with that.
I was required to pay for mine out of pocket a bit under $500. It may be that was because I started Dexcom in January, or it may be my particular plan. I see where some have the device rented, others it is covered and still others like mine require purchase.
Same issue with Edgepark. what did you do to resolve it? And if you had to purchase a receiver, are you still eligible to receive one through medicar in 2024 (when I am eligible as well).
Do you have standard Medicare with a supplemental policy or do you have a Medicare Advantage policy? From your earlier comment upthread, it appears that Edwards Health Care Services interprets Medicare policy as requiring a G7 receiver or it will not ship sensors. Did I get this right?
@susan4, are you posing your question to me? US Med just sent me the G7 sensors and omitted the G7 receiver. They made it seem like a routine procedure. They said they will send the G7 receiver in 2024 when I am next Medicare eligible for one. In the meantime I can use the Dexcom G7 app on my iPhone.
It is a Medicare Advantage provided through my former employer, Verizon. It is really quite good overall. I know there are a lot of Advantage plans that are scams or close to being scams. We have a low monthly premium with really good coverage and fairly low co-pays.
What I wonder on the issue on receivers being required - what about those using a Tandem which uses the receiver Bluetooth channel?
I am currently thinking of staying with the G6 as long as possible because of connection issues with the G7. It sounds like the pump will need to be very close to the sensor, closer even than with the G6.
Terry,
I have a standard (original) Medicare policy with supplemental coverage. I believe I am required to use Edgepark as my supplier.
Here is my quandary, I tried the G5 and received a receiver, transmitter and sensors. This was some time before 2019. In February, 2019, I switched to the Freestyle, and received a new receiver and sensors at that time, but switched back to Dexcom once the G6 was introduced. I was not asked to get a new receiver.
The last Dexcom receiver I had was prior to 2019, and of course, the Freestyle receiver doesn’t work with Dexcom.
All that was patiently explained to the Edgepark folks many times, up through the ranks. It didn’t matter that I never had a receiver for my G6, and indeed, probably threw out the old one years ago. What mattered to Edgepark because they said it mattered to Medicare was that the last receiver I got was in 2019, even though it was for a Freestyle.
Therefore, to them I am not eligible for a new receiver or for the G7 sensors until 2024.
Wondering if you might have some insight or a work around. You are so knowledgeable and informative!
Best,
Susan
Are you sure? I suggest that you call US Med and inquire if you might purchase from them - there may be some geographical restrictions. I do know, however, that US Med does business in every state and is Medicare compliant. (I have no relationship with them other than as a satisfied customer.)
Remember, this transaction will be conducted under Medicare Part B (not Part D, the private drug program that definitely can limit which company you can do business with) and your preference of suppliers should not be overridden by Medicare itself. Your Part B, DME suppliers do, however have to be qualified.
Medicare has lots of rules I don’t completely understand, but vigorously exercise your curiosity.
Your situation reminds me of my quest to get test strips covered by Medicare. I was trying to get them to pay for Contour Next strips that CVS had supplied me. They kept refusing, saying that I did not have the required meter. I had purchased the meter out of pocket but they didn’t care. They had not supplied me with the needed meter because they had supplied me with an Accu-Chek Aviva meter less than five years prior. I gave up the effort when I realized that Medicare would not likely pay for both CGM coverage and meter coverage except under very limited arrangements.
I have a feeling that your Freestyle CGM Medicare purchase in 2019 makes coverage of another CGM before 2024 unlikely. I think your best bet is to get someone at a supplier like US Med interested in your case see if they have any ideas. At least 2024 is less than 6 months away. Good luck.
I have no idea about coverage under a Medicare Advantage plan. They make their own rules and can change them at any time.
As far as I know, Tandem has not worked out the CGM connection to the G7 yet. I know that Tandem uses the pump itself as the primary display device and doesn’t use the Dexcom receiver.
The G6 may be the more dependable technology for you. Nothing wrong with that. I held back on the G4 CGM until Dexcom shut down their G4 servers. At the time, most users were on the G5 and G6. Being able to restart the G4 sensors permitted me to build up quite a reserve of G6 sensors before I was forced to switch over.
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If all else fails, wait until the open enrollment period this fall and change plans.
I have a Medicare Advantage plan, and love it. It’s with a small, regional company (Capital Health Plan), so unless you live within about 50 miles of Tallahassee, you can’t get it. Do research. Some plans are bad, some are excellent.
I have popped back in here because I got a sample G7 today from my endo. So far, I’m leery. It was reading 60 points low until I calibrated. And twice already it has registered sudden spikes. Not encouraging. I want the new features but not at the expense of reliability.
Edward
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I just talked to US Med about sending me G7 sensors. The young woman I talked to told me that my next order, in early August, will include G7’s and a new receiver. Previously I had been told that I wouldn’t receive a new receiver until Fall of 2024. I asked her about this and she said that Medicare is having a special and that I will be receiving a new G7 receiver.
That is a nice surprise. I am wondering if my secondary insurance is picking up the bill or if Medicare really does have specials.
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Medicare-approved amount
$255.01
Medicare paid
$199.93
You may be billed
$51.00
That is my normal monthly Medicare payment to CCS Medical and the $51.00 is covered by my BCBS supplement, so I pay nothing.
In July I was upgraded from the G6 to the G7 and my monthly Medicare billing did not change from the previous months. The only changes were that in July I was sent my regular sensor allotment + a G7 receiver. This is the same process I have gone through every time Dexcom upgrades its sensors. They have never asked me to return any of the receivers.
CCS bills Medicare for DME $1,150.95 every month but Medicare only pays out $255.01
Ok, I won’t see anything since BCBS will pick up the cost. We pay a huge amount for BCBS though and are thinking of dropping it.
My husband is getting his knees replaced, so it will be interesting to see how much BCBS pays.
I have been asked to return the old receiver.
You can go to Medicare.gov and look up your account or set up an account if you don’t have one and see exactly what your supplier bills, what Medicare approves and any copay you may have if it is not covered by a supplement. If you click on claims details, you can really get down into the weeds with the billing process. It costs nothing to sign up and it is nice to see everything Medicare related in one spot. You will find an amazing amount of information there if you are not used to using that site.
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I will have to decide on a supplemental plan in the fall for next year. My current employer gives me zilch. I am in Naples, FL. My main concern is G7 and OmniPod. Is there a clear choice or a short list?
No, not really as everyone has different wants and needs. It makes a difference, if for example you are MDI (Multiple daily injections) or on a pump as that dictates what will be picked up under part B or part D. It also depends if you wish to use an online pharmacy or pick up your medications and supplies at a pharmacy. There are also all sorts of coupons available through GoodRx and their competitors so you need to look at the total cost of drugs and supplies, co-pays, and along with the insurance premium costs. There are many cost savings options available, from coupons to ordering drugs and supplies from other countries such as Canada. Your options are really specific to you and insurance companies periodically change their coverage rules. The first year is hell because you need to make a spreadsheet, get quotes and then decide what works best for you. Keep your spreadsheet as there will be few changes year to year and you only need to look at changes to your plan and decide if you want to reup on the same plan or go elsewhere. People’s needs change and plans change so this is not a fun game but a little work up front can save you thousands of $ annually.
Thanks, @CJ114. I realize my typo now. I should have said G7 and OmniPod. I will not go tethered even if I have to pay out of pocket. OmniPod seems to be the most expensive piece of equipment that I need. G7 seems to be less expensive and easier to cover. It is unfortunate that old people like me have to be hassled by the bureaucrats that we finance.