Medicare and G6 cost varies each month?

I have been using the G6 now for about a year, but only since February 2021 on Medicare.

I’m confused about the cost to me. Each time I get a new 3 month Rx, the first filling (one month) is zero dollars and the next two are always $45.

When asked about it, the response is that’s what Medicare says. I haven’t pushed it but I will now. It just makes no sense to me.

I assume I need to call Medicare directly for an answer. I have never called them so this should be interesting and I hope not a long long wait to get someone only to be transferred.

My original provider managed to get one Rx completed in 4 months and I switched. The new provider got it cover and ready to go in 2 weeks. This is my only problem with them so I feel like I’m winning, somewhat. The cost thing just bugs me.

Any suggestions before I call Medicare?

Are you on traditional Medicare as opposed to Medicare Advantage? Medicare Advantage is actually private insurance whose rules vary somewhat from Medicare rules.

People who subscribe to traditional Medicare often sign up for a supplemental plan that picks up what Medicare does not cover. CGM supplies, insulin used in a pump and insulin pump supplies, are covered under Medicare Part B. Part B is what allows me to enjoy zero dollars out of pocket coverage for my pump insulin, pump supplies and CGM supplies once I pay my annual Part B deductible.

Many pharmacies are not familiar with administering Part B prescriptions and end up filing under the more common and familiar Part D prescriptions coverage. This will end up costing the patient more money.

One question to ask your pharmacist is whether they are processing your CGM order under Part B or Part D. This is a common source of error. Medicare Part D is a private Rx plan whose rules vary greatly from plan to plan. To further complicate things, Medicare Advantage integrates Rx coverage into their overall plan which eliminates the need for a separate Part D plan.

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I am not using a Medicare advantage plan, just the regular Medicare part B. I also have a part D drug plan.

If I understand you correctly, I should call the pharmacy and ask which plan they filed it under and if they filed under part D, to refile it under part B? Is that correct?

It is a nationwide pharmacy. I’m not sure if it’s ok to name it here.

Thanks for your assistance.

Do you also have a Supplemental Plan? If so they would probably pay the 20% that Medicare does not pay. Basic Medicare pays 80% of the contracted monthly rate for Dexcom and the $45 is what my Medicare info says I would be responsible for if my Supplement Plan didn’t cover it.

Why you are not being charged $45 every month is very weird to me and I have no idea what is going on. Dexcom is not covered under Part D with Medicare so I don’t think that your Part D plan is involved in this. But who knows?

I think you will get more information from your pharmacy than Medicare. Usually phone calls to Medicare are answered by people who won’t have a clue what you are talking about. Also do you have an online Medicare account and can look at your claims and EOBs. That should clearly show what is being billed and when.

I agree with @Laddie. Check with your pharmacist and see who actually paid for the various transactions you conducted with them. If they filed incorrectly under Part D, or some other party, you might have difficulty getting that reversed.

The issue was solved, in 1 minute! I went back to the original pharmacy that set it up for me 6 months ago. It’s a specialty pharmacy in the National chain. I was referred to them to set it up as my previous DME provider just could not get it working in 4 months. The new one took 2 weeks.

The problem was simple. My supplement was not being filed consistently and the $45 charge was popping up when they only billed Part B. The first pharmacy could have figured it out easily if the tech cared enough to try.

Yes, I did go online to their customer service website and write a scathing rebuke of the pharmacy tech who refused to do anything but say call Medicare and refused to transfer me to the pharmacist to try and clear it up. Horrible service. I really don’t like to write complaints but her rudeness, surely attitude and refusal to let me speak to the pharmacist was just plain wrong.

Thanks for the suggestions folks! It is solved!

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