Will the Dexcom G7 lose Medicare Part B coverage?

Something has to be durable to be covered by part B. This is th problem with the OmniPod. It is all disposable.

On 2nd thought the OmniPod should be covered because of the PDM controller. Maybe next year.

It seems like all of the manufacturers are moving away from durable everything. Making everything disposable.
It adds to our medical waste and our cost.

I remember when insulin pumps had reusable syringes and tubing that lasted months.

I didn’t have a pump back then, but I considered it. But one of my pet peeves is the medical waste.

It wouldn’t surprise me if Medicare dropped Cgm and pumps, it took years for them to bring it on line.
It’s not an irrational fear, it’s actually pretty likely.

OK, I will play again. @Timothy , @Terry4 , once the G7 is ‘inducted’ into the armamentarium of of the the CIQ or similar software driven PUMP, there is your durable.

The key is how do you sell ice cubes to people living in the polar regions? By explanation.

I will keep my seat in the balacony as either Statler & Waldorf. @MM1 has it in his post. Similar to the line from GONE WITH THE WIND, “it is the land (pump) Katie Scarlet, its the land (pump)” Demonstrating the durability clause.

Cheers.

Hope this helps demonstrate this is a moot thread until…

That was so veiled in metaphor, I have no idea what you are saying.

2 Likes

For G6, the receiver is the durable for Medicare’s purpose.
In a different topic, I mistakenly raised the question based on thinking the transmitter was the durable part. This topic was a spinoff of that.

G7 will be likely be available with a receiver for those not using pump or phone app. Medicare will likely require the G7 receiver to be purchased regardless of you having an Integrated pump as “receiver” since that’s how it worked with G6. Or Medicare may or may not allow specific pump to be considered the durable device. In no case will it allow a phone app to be the only receiver as the DME, as mentioned by @Robyn_H .

Loop users may have a unique situation.

Other insurance may follow MC, or may allow use of any “receiver” without restriction of receiving device/app purchase or type.

1 Like

Medicare did not buy or require a receiver as I had an integrated pump.

Back to the drawing board.

| MM1
October 18 |

  • | - |

Jay6:

once the G7 is ‘inducted’ into the armamentarium of of the the CIQ or similar software driven PUMP, there is your durable.

For G6, the receiver is the durable for Medicare’s purpose.
In a different topic, I mistakenly raised the question based on thinking the transmitter was the durable part. This topic was a spinoff of that.

G7 will be likely be available with a receiver for those not using pump or phone app. Medicare will likely require the G7 receiver to be purchased regardless of you having an Integrated pump as “receiver” since that’s how it worked with G6. Or Medicare may or may not allow specific pump to be considered the durable device. In no case will it allow a phone app to be the only receiver as the DME, as mentioned by @Robyn_H .

Loop users may have a unique situation.

Other insurance may follow MC, or may allow use of any “receiver” without restriction of receiving device purchase or type.

Is it an Advantage plan?

No…. Medicare & FEP

If you are using a compatible pump or receiver, covered from prior insurance, that is valid.

If you are using phone app only, then your plan is not following MC rules.

No, trad Medicare & FEP

| MM1
October 18 |

  • | - |

Jay6:

Medicare did not buy or require a receiver

Is it an Advantage plan?

The medicare information is very helpful to me because I will be starting medicare in Dec 2020.
I really appreciate the comments that I read on here a someone new on medicare.

Thanks,

I honestly think you’ll be OK with DME coverage. Here’s my thought process:

1.) It took forever to Dexcom coverage through Medicare. Now that its been established, people will show up with with torches and pitchforks if they take it away.

2.) There’s no way that the cell phone is considered “DME.” That’s gonna be an outside of policy thing. So, if Dexcom needs to sell it without the receiver, I’m sure they will do that in order to protect your coverage. Your a massive part of their customer bases. Medicare coverage is the primary reason you see so many Dexcom ads on TV. That’s not going anywhere. There’s too much money involved.

3.) Lets say that coverage IS lost for the receiver. Since this is a Medicare issue, the way to fix it is through legislative effort because the government controls what is covered through Medicare. That’s ‘relatively’ easy to fix, compared with private policy formulary coverage. Medicare is full of ‘hang ups’ and they make these fixes every session - both parties are well accustomed to doing it.

I do think you have reason to raise the DME issue. Its a concerning thing that effects a lot of people. But don’t worry too much.

If you had to stay on G6 until policy caught up, you’d be ok for a little while.

All they would need to do is write one sentence into policy that Dexcom is not subject to the DME rules. If they had to, they would do that, I’m sure. Its particularly important to healthcare providers now, to have access to that equipment, because of covid and virtual care and stuff. If they wouldn’t do it for patients (which, they would), they would do it for providers.

This would be both a T1 and T2 issue. T1’s bring tenacity to a fight, but T2’s bring the numbers. If you have both on board, things move quickly.

4.) No one would even conceive of trying to take Terry’s Dexcom away. They would have to tear it from his cold, dead hands.

They don’t want diabetics to come knocking on their door about this. They are sick of us. We are always bitching about something or other. Diabetics have an established relationship with lawmakers because of problems like this. We are the ‘tough guys’ of chronic illness communities. Even when we ask them to do things that are fairly insane, they end up doing it. That’s because we are such a pain in the butt, bordering on criminal sometimes. We’re like a terrible patient motorcycle gang to them. They get nervous when we roll up because we tear the place apart, either way. The diabetics are always looking for a fight.

1 Like

@Terry4, Can you spell out, very directly, the hang up your seeing. I’m not sure I understand. Your concerned about “non-durable coverage?”

@mohe0001 – My premise for posting this thread was based on my temporary forgetting that it’s the receiver, not the transmitter that performs that function. I knew that in order for the Dexcom system (sensor, transmitter, receiver) to be covered under Medicare Part B, it needed one component to be considered durable.

One of the eligibility hooks for Part B coverage is based on durable medical equipment or DME. There are other things that make a product or service covered under Part B, beyond DME, like prosthetics.

With the news of the G7’s appearance with its integrated transmitter, I worried that the transmitters non-durable nature would threaten Medicare’s requirement for Part B. What I had forgotten about was the fact that Medicare viewed the receiver as the DME hook and Dexcom’s transmitter evolution from the G6 durability to the G7 throw-away shouldn’t make any difference to Medicare.

We will need to wait for the G7 to show up in the US and see Medicare’s actual policy but I think Medicare coverage for Dexcom CGMs will remain.

I hope the G7 will perform at least as well as the G6.

1 Like

There may be an interpretation change of the device definition to include CGMs as a DME because it will be going to a pump (more than 3 year life), or a display device (another medical device) to achieve the definition. Dexcom will not want to loose a large percentage of its customers because of a Medicare definition conflict. This info came from a Congressional staffer who also wears a Dexcom G6.

1 Like

That would work for those who use a CGM linked to their pump, or potentially linked to their pump, but still leaves those who use non-compatable pumps or do not use pumps at all, just a CGM, in uncertain territory.

If your only device to display your CGM data is your phone, I would likely agree with the uncertainty of Medicare coverage. It appears to me, however, that Medicare has given up on that objection. I could be wrong but I believe many still in that circumstance retain Medicare coverage.

I think having the receiver as a backup is good idea.

3 Likes

I am MDI, not on a pump, and use only fast-acting Humalog to control my BG.
Currently using the Dexcom G6, but when the G7 comes along, like all past upgrades, The Dexcom coordinator at Joslin diabetes center in Boston will just put through whatever paperwork is required and Dexcom will ship me the G7. I am really not worried about future Dexcom tech as it keeps improving and Medicare keeps on covering the expense. It would not make sense for them to go backwards.

1 Like

The main point is not the transmitter or sensor, but how you receive the data. You need a device, and Medicare won’t cover the cost of a phone to be the receiving device.

So as long as you purchase G7 receiver or supported pump, or use a compatible phone with Dexcom G7 phone app, or use a dyi app (eg xdrip), then you’re all set.

Yep, I was required by Medicare to purchase the receiver. As I am now on a pump, the receiver is in one of my D drawers.

1 Like