I am not on the Omnipod which is covered under Part D but that will be quite a bit more expensive than your Dexcom supplies. Your best Part D plan will depending on what other drugs and quantities you need that will also be covered under Part D. Here is a good starting point to compare plans.
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Thanks @CJ114. My other drugs cost almost nothing. I can get them from Amazon for less than $15/month. Thanks for confirming that my focus should be on OmniPod. What I am most worried about is that a Part D plan might cover OmniPod next year but drop it thereafter. I still cannot wrap my head around why a private insurance would cover OmniPod for less than the cost of OmniPod. Does not make any sense to me. I guess I will be much more knowledgable by the end of the year.
On Medicare, certain insulins are capped at $35/month now, so if you are self-pay, MDI, although less convenient in some cases than Omnipod, is an alternative perhaps worth considering, especially when adding up plan premiums, copays, donut holes, insurance hassles, annual review, etc.
@CJ114, I have enough money to pay for everything out-of-pocket. This does not mean that I am not interested in saving money when I can. I have no intention to compromise in response to cost. At least not for now. As Yogi Berra said: āIt is difficult to make predictions, especially about the future .ā
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I havenāt picked them up yet, but basically yes, although of course itās 3-1/2 months later.
Last week, after running a sample G7, I told my endo to put in the prescription. I expected them to place it with the DME provider Iāve been using, so I was surprised when I got email from my local pharmacy. They verified that the order is for nine sensors and no receiver.
This has been my regular local pharmacy (Publix) for several years, and Iāve had the same Advantage plan for even longer. So Iām sure itās been approved. I donāt know when the pharmacy channel was approved in addition to the DME channel, so perhaps thatās also a difference.
The co-insurance for nine sensors is $190. Iāve been paying about $25 less for nine G6 sensors (delivered three at a time). Is this typical of G7 vs G6? Just wondering if itās worth checking with the DME provider before picking them up from the local pharmacy.
And does anyone know if using a local pharmacy puts the sensors into Part D instead of Part B? If it does, I will have to start looking at the coverage gap again.
I have a couple of old phones which should be able to run the G7 app, though Iāll have to try installing it to be sure. If that works, I figure I can hang on to one of those phones as the spare receiver in case my phone gets run over by a truck.
Edward
Thanks for your reply, Edward. Iām glad to read that you have coverage of the Dexcom G7s. I am most interested in people who have traditional Medicare coverage. I understand that Medicare Advantage plans have various policies. Traditional Medicareās handling of this issue is what Iād like to know from other members here.
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I have traditional Medicare and use the G7. Medicare picks up the 80%, per usual, and I get three months of supplies with each order from USMed. I notice on my Medicare billing summary that USMed gets reimbursed by Medicare monthly. I have a receiver but Medicare doesnāt know about it - I bought it outright without a prescription.
Thanks for reporting your experience, Mary. I, too, noticed that US Med bills Medicare and gets paid monthly. Iām going to look into getting a G7 receiver that I will purchase out of pocket.
I recently went through an iPhone corruption and think maintaining a separate Dexcom receiver is a worthwhile redundancy. Hoping it doesnāt cost too much. I still have some residual G6 sensors to use up but the G7 horizon is getting much closer to me.
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Check the GoodRX site. G7 receiver around $65-75 oop.
(From my local stores.
RX required, no insurance cost. )
Thanks for the tip.
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US Med sent me a G7 receiver along with my sensors.
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Had it been five years since Medicare paid for your last Dexcom receiver? US Med told me that I had to wait for the five year anniversary of Medicareās payment for my last G6 receiver.
I didnāt want to push back too much since they have been shipping G7 sensors, a benefit I doubted.
Terry, I was very surprised that US Med told me that they would send a receiver, because previously they had said Sept 2024. I questioned them and they said that Medicare was having a special. They do want my G6:receiver back.
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I have three old Samsung phones. I just installed the G7 app on one of them. Iām planning for that to be my redundant device, since (as discussed above) I havenāt been required to get a G7 receiver. I havenāt actually connected the phone to the sensor, since that would interrupt its connection to my in-use phone, but that should be trivial when and if required.
If you are only considering the receiver for redundancy, you might ask around to see if someone you know has an old phone (either Android or iOS) they arenāt planning to use again.
It doesnāt really matter that you are normally an iPhone user ā you would only be using the old phone for the G7 app, and the phones arenāt much different for that purpose.
And of course you donāt need a SIM ā in fact, since a SIM-less phone can still reach the Internet via WiFi, it can still share data and send to Clarity, thus is more capable than the receiver.
And what will they do with it ? Iām surprised at this request.
I was guessing they use them as āreconditionedā replacements for receivers that fail under warranty.
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The policy appears to be unclear among providers, Dexcom, and Medicare, as I was told by CSS Medical when I upgraded from the G6 to the G7 that they would give me a G7 receiver but would want my G6 receiver back. My new G7 sensor and receiver supplies came several months ago, and they have yet to ask for my G6 receiver back. With previous upgrades, I was never asked to return the receiver so I donāt think they will send me a return package for the G6 receiver.
Included in the USMED box was a page of instructions from Dexcom. I am supposed to use the box that the new G7 receiver came in. The page also listed shipping details. I have several G6 sensors which I plan to use before I return the G6 receiver.
I also received an email from Dexcom before my sensors and G7 receiver arrived reminding me to return my G6 receiver.
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Thank you so much for the heads up - My Bad!!!. I did not receive a reminder email from Dexcom but just double-checked the shipment with the G7 sensors and new receiver, and sure enough there is a folded instruction sheet at the bottom of the box with instructions for returning the G6 receiver. So far I have ignored it and continue to receive additional G7 sensors while I am using up my G6 stock. Will see how long they let me ride this out but I would not be surprised if they just eventually ignore my lack of return, or perhaps several months down the road, when I start using my G7 supplies, they may wake up and bug me for the G6 receiver.
I have been using the G6 for several years. I carry both the receiver and my iphone. I have many more signal losses on my phone than I have with my receiver. In January I will be getting the G7 and a receiver.
Do most carry both or only your phone?
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