Medicare and Edgepark


#1

Edgepark says they are not contracted with Medicare for the Dexcom G5 CGM. I have also learned that in 2019 Dexcom may be giving Medicare patients the new G6 with coverage through Medicare. As I learn more I will let y’all know.


#2

And apparently they’re not contracted with Medicare for insulin pumps either. Due for a new pump, and am searching for a supplier. So far Medicare.gov gave me a supplier in my area who does NOT carry pumps.

Sometimes life can be so frustrating!


#3

@Ruth4
Which pump are you looking for?

Perhaps somebody here can FYI you in regards to a particular pump with a particular distributor in regards to Medicare coverage.


#4

@Bonnie65
Here is a news article which also confirms the information you have.
Not as specific as the particular distributor that you mention but more in general for G6 and Medicare coverage.

… the new Dexcom G6® CGM System will be covered for Medicare beneficiaries …

The company [Dexcom] expects to begin shipping product to Medicare customers in the first part of 2019.

EDIT:
I know there have been discussions about whether the upgrade to G6 from G5 would be forced or voluntary. At least near term, the following two quotes from Dexcom would appear to show this as being a voluntary upgrade to G6 for Medicare recipients.
Certainly that is a fair amount of speculation in terms of how the process works until it is actually rolled out and people report back how it works in practice.

  • Once G6 is available, Dexcom will be reaching out to current Medicare G5 customers when their transmitter is eligible to be replaced.
  • Dexcom will also discuss the G6 and the Medicare beneficiary’s eligibility during routine monthly contact.

#5

@Ruth4 have you contacted the pump manufacturer to have them check your benefits?


#6

It took me about 3 months to get to the right person that could help me. Ever have a day when you think I called that person. Well on the 2nd try to the doctors office I got the phone number of the person to contact at Dexcom. She was GREAT! But I’m still waiting to find out what is next. I believe they are checking and rechecking my insurance. One day we won’t have to do all this work just to get something we truly need. Oh Medicare where art thou?


#7

When i talked to Dexcom, i was told that the G6 is so back ordered not to think about getting it for 6mos


#8

I’m happy with the G5 but still waiting on supplies. Medicare is so slow sometimes. UGH!


#9

I have a medtronic pump, the 523. I don’t need a CGM. Once I get through Chanukah I’ll call Medtronic and see what’s what…and maybe I’ll call Byram, too.

Ruth


#10

If you are considering Medtronics, they no longer sell 523. The 530 is similar design to 523, but they may have stopped new purchase of that. You can check their website.

I have only used Medtronics for past 20+ years, but next one most likely to be Tandem, since I don’t like the newest models.

Unfortunately each plan seems to dictate which suppliers, and may vary by state.