Hi, I have recently moved to Texas from Dubai and I am in the process of finding medical insurance that provides coverage for Dexom G5. From what I understand, Dexcom does not supply directly in Texas so I need to go to a distributor but no one is able to explain which insurance will cover my Type 1 diabetes needs. Any suggestions?
@Ash10 - If you call Dexcom directly, they are great at working with distributors and insurance companies. They can probably give you a list of distributors who would work specifically with your insurance and location.
I live in Texas and the only trouble I have with getting Dexcom supplies is when insurance wants to cover it as durable medical instead of as a pharmacy benefit. Depending on how your insurance covers it, you should have no trouble finding a distributor that can send you the supplies.
Ex: Currently I have United Health Care with OptumRx as the pharmacy provider. They cover the Dexcom as a pharmacy benefit, but I can’t buy the supplies from Dexcom, I have to go through the OptumRx mail in pharmacy.
I will be changing to Aetna in January and they cover Dexcom as durable medical equipment. At that point, I believe that I will be able to order from Dexcom, although, it will be a higher rate as prescription drug coverage is cheaper than durable medical equipment.
Be sure to talk with your insurer and possibly have your doctor speak with your insurer, sometimes the doctor can get an insurer to bend their coverage based on ‘medical necessity’. Either way, the insurer should be able to give you a list of covered providers for the Dexcom supplies.
Best of luck, I know that the Dexcom system is life changing for me and I would hate to have to give it up.
I’m in Texas. My daughter’s Dexcom supplies come from Dexcom.
I believe moving qualifies as one of the circumstances for special enrollment, though open enrollment for everyone in the private market starts Nov 1. Regardless, you can see what plans are available in your area & compare coverage on healthcare.gov. Some documents were not available when I logged in this morning, but I could see the plans, prices & physician directories.
Thanks for your response. Is your insurance through marketplace? If so, which provider do you use and which plan do you have? Even if it is not through marketplace, could you please let me know which plan you have. I do not mind a higher premium as long as I know I am covered.
Someone recommended BCBS but the provider would not give me any specifics on whether dexcom is included in the coverage or even insulin for that matter. Their response was that I need to buy the coverage to find out what it covers and I do not want to pay a premium of $533 to find out that what I need is not included.
Thanks for your help. It is not exactly easy understanding health care when you are new to the USA
Thanks
@Ash10, we only have 2 choices in our county. BCBS & FirstCare Health. My daughter has FirstCare. In 2016 we bought it through the exchange. For 2017 the plan wasn’t offered on the exchange so we bought it directly from FirstCare. It’s the same plan we bought through the exchange, just at a higher cost. Any plan not purchased through your employer is considered a marketplace plan.
That’s why I suggested you go to the exchange site to view plans for your area. You can see the coverage for labs, DME & prescriptions for each plan. You do NOT have to purchase a plan before finding out coverage.
We had BCBS when she was dxd in 2009, actually until 2014. They covered Dex. My only complaint was having to use Edgepark. Their prices were ridiculous. Until we moved to FirstCare, we had never paid less than $150 per box of sensors, & that was our 20% coinsurance. BCBS contract rates sucked.
Thanks. That helps! Will look in to firstcare health and take it from there