From other posts, it appears that in order for Medicate to cover the cost of the G6, you need to see your Dr. at least once every 90 days (if you use a pump). And, if you get coverage for the G6, then Medicare will not cover the cost of blood glucose test strips. My question relates to the above events. If, for example, you only see your Dr. every 6 months, Medicare will refuse to cover G6 supplies during months 4 through 6. If during that 4-6 month period, would Medicare then cover the cost of test strips and if not, what excuse would they use? Just curious if anyone has tried this?
From my understanding they will cover test strips or a Dexcom. When I asked them about it, they have the test strips listed as not needed with a Dexcom. If the test strips were bundled still with the Dexcom like the G5 was, then it’s covered. I am assuming this is the way Dexcom got the G6 approved by Medicare to help offset costs to Medicare, or it was a cost saving measure by Dexcom because they didn’t want to supply test strips anymore at a reduced rate. Since they are switching the shipping to other companies I am suspicious it was a Dexcom decision to make it a more profitable deal for other companies to be able to supply it.
It’s really ridiculous as in their own tutorial they say to test when in doubt use your meter. My last newly started Sensor was 60 points higher 12 hours later than I was actually at. I hadn’t calibrated at all yet.So supposedly you don’t ever have to check it or calibrate it? Absurd.
I believe the 90 days is to get any supplies covered by Medicare. I could be wrong about that as I haven’t actually asked.
You are correct the 90 day rule applies to all medicare pump users. The 180 day rule applies to all medicare MDI users. I am on the 180 day Dexcom medicare plan so if I do not get doctor notes to the supplier of my Dexcom equipment within 180 days, all replenishment and shipments stop. If my doctor supplies notes on say day 200, then the supplier will reactivate subscription on day 200. Not 1 day before. And yes, if you are on the G6, medicare will not cover the test strips, regardless of the number of days, pump or MDI plan. In the example above, no, medicare will not pay for test strips between months 4 and 6 as they still view you as a G6 user, just delinquent for a couple of months in supplying doctor notes.
CGM coverage by Medicare requires a doctor’s visit every 180 days.
Pump supplies unfortunately require a visit every 90 days. So for those of us with a pump and CGM, we are required to visit the doctor every 90 days. Fortunately a telehealth appointment satisfies this requirement and makes life easier since for me these extra visits are unneeded except for Medicare rules.
Medicare does not consider the Omnipod to be a pump and it is not covered under Part B DME. It is covered under Part D prescription coverage. And Part D does not have the 90-day visit requirement. I think it just requires an annual prescription and maybe (?) a letter of medical necessity.
So if I understand Medicare coverage, if you are using an Omnipod and a Dexcom, you only need a doctor’s visit every 90 days. But you would need to confirm that with your Part D prescription plan. If you have an Advantage plan, you need to confirm everything with that plan.