I ‘m new to medicare in February. Does part B fully pay for the Dexcom G7 sensors as a DME?
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Yes, it is DME.
Good description here
You need to have Dexcom receiver or tandem pump as receiver. But then just use phone for data/reporting.
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It depends on your plan. Medicare Part B covers, I believe, 80%, and then your supplement, if you have one, covers the other 20%.
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I’m thinking the 20 percent runs around $50 to $60 per month. I haven’t figured out what the transmitter for the 6 cost and I’m not using 7. Medicare is such fun.
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I find buying the Medex supplement well worth it. That covers not only my Dexcom 20% but no copays for anything, and I am covered globally. What is excellent about Medicare is that you can research the best doctor/surgeon in your area when you need surgery or any medical procedure. Chances are they accept Medicare, and you don’t need a referral.
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As someone said, it depends on your plan. Straight forward Medicare Part B only and you will have a copay. (and the donut hole to deal with) But if you have a gap or supplemental policy with it that covers the copay then you shouldn’t. If under an Advantage plan, it can really vary if you pay and if it is even on their coverage list. Cheaper up front but your choices on everything goes down, that’s how they keep down costs.
Your drug Part D coverage with Medicare original is different and will depend on what plan you pick. While pumps and CGM’s are covered under Part B there are some quirks. Insulin is under Part D, unless you have a pump, then the insulin will be under Part B too. Patch pumps (Omnipods only for now) are differently covered under Part D and your insulin for them will be under Part D too.
https://www.medicare.gov/plan-compare/#/?year=2024&lang=en
https://www.medicare.gov/medigap-supplemental-insurance-plans/#/m?year=2024&lang=en
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Is that a gap plan? I just got on Medicare in October and qualified for QMB, meaning they were paying my copays on anything Medicare didn’t cover except RX. My husband got the dumb increase for 2024, and which took me out of that program and now will only cover my monthly premium. And I don’t even qualify for full retirement until 66 yrs 8 months.
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“If under Advantage” would have been a significant disadvantage for me because I travel extensively, and the Advantage plans restrict you to in-network doctors. Individuals on Medicare often have more time, money, and desire to travel, a downside not adequately stressed in promotional materials.
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Yes, Medex is a Blue Cross Blue Shield gap plan that offers two to three plan levels with slightly different benefits and costs. My experience has been the plans available for new members vary from time to time, but once you are on a plan you like, you can keep it even if it is no longer available to other new members in the future.
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I want to emphasize that Medicare Part B only pays 80%, as was mentioned above. Some information sites just say, “if you’re on a pump, Part B pays for your pump and supplies; otherwise you need a Part D plan.” They omit the 20% copay for the former situation. I’ve pumped for over 25 years, but recently I forgot the 20% myself.
—Keith
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The person I take care of has a G7, sensors are paid for by Medicare as DME, but you ahve to go through a supplier. However, you are entitled to test strips becuase you are supposed to be testing along with the G7 . The local pharmacy is not allowed to provide you with test strips under Medicare, You must go through your DME provider.
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My brother has Medicare and a Medicare supplement. He gets test strips at a local pharmacy and it’s covered by Medicare.
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Also, he has an insulin pump.
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Does your brother use a CGM too? I’m interested in how to get Medicare coverage for both a CGM and test strips.
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Be aware, you need to have been seen by a diabetes professional within the three months before you are allowed to get the Dexcom. I just started Medicare last month and it has been a s-show trying to get a refill of Dexcom. I’m back to fingersticks for a while. So very disappointing. There have been no questions about getting insulin refilled. I don’t understand why they focus on Dexcom.
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My Dexcom 7 order has been seamless with United Healthcare. It comes via Advanced Diabetic Supplies. I turned 65 last February and my endo appointment was the previous October. I go twice a year.
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I don’t get it! Why is Medicare insisting I see my doctor every three months but you can go six months?
I just heard that my Dexcom order has shipped and should be here in a few days. But they will only supply a month at a time. I’m nervous about how this is going to go.
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If you are on a pump, medicare requires you to see your doctor and have your results available every three months.
If you are MDI (Multiple daily injections) Medicare requires you to see your doctor and have your results available every six months.
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Ohhhh… I tried the Omni pod for about a month. Didn’t work out well and I went back to MDI/Afrezza and Tresiba. I guess someone somewhere was looking at the Omnipod record.
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Here’s a recent topic where we went over the Medicare part B coverage requirements. Note that if you signed up for a Medicare Advantage plan you’ll need to refer to your plan’s documents.
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