It’s truly amazing all the medical breakthroughs scientists are making these days. One of those breakthroughs is changing how people monitor their blood sugar levels.
With continuous glucose monitors, or CGMs, you are now able to track your blood sugar level in a less painful and invasive way. Plus CGMs are more accurate in keeping track of your blood sugar level compared to the “traditional” way of doing it.
One of the well-known CGMs many are using today is the Dexcom G6.
This has led to more and more people asking the question “Does Medicare cover Dexcom G6?” In this article, we answer that question in clear, plain English. You will also find the average costs of Dexcom G6 and other helpful info.
Does Medicare Cover Dexcom G6?
The short answer is yes; Medicare will cover the cost of Dexcom G6. But not 100% of the time. As is often the case with Medicare, certain conditions must be met in order for Medicare to pay for your Dexcom G6. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for Dexcom G6. Coverage for a Dexcom G6 is provided by Medicare Part A if the system is administered to you while you’re in an inpatient setting (as long as it is medically necessary).
However, coverage for Dexcom G6 usually falls under Medicare Part B. In most cases, Medicare Part B will cover Dexcom G6 equipment under a fee-for-service agreement. The Dexcom G6 is considered Durable Medical Equipment (DME) which Medicare Part B covers.
For Medicare Part B to provide coverage for your Dexcom G6 equipment, you need to be diagnosed with type 1 or type 2 diabetes and require insulin therapy.
There are other requirements you’ll have to meet in order to get Medicare Part B cover Dexcom G6 equipment too. These requirements are:
- You have been using a home blood glucose monitor (BGM) and you are performing a BGM test at least 4 or 5 times a day.
- You’re administering at least 3 shots of insulin every day or using a continuous subcutaneous insulin infusion (CSII) pump
- If your insulin regimen requires frequent adjustment based on your CGM tests results
- You have a receiver that is compatible with Dexcom G6 and you use the receiver with your supplies. Medicare does not cover if your Dexcom G6 supplies are only used with mobile devices
Original Medicare beneficiaries who are prescribed the Dexcom G6 system are required to schedule a follow-up appointment every six months for testing. If you don’t follow this requirement then Medicare Part B will stop providing coverage for the Dexcom G6 system.
Usually Medicare Advantage plans (Medicare Part C) provide coverage for everything Original Medicare covers. However, that does not currently appear to be the case for Dexcom G6. This is because the manufacturer of Dexcom G6 does not accept Medicare Part C.
So if you are enrolled in a Medicare Part C plan and you need GCM equipment or traditional testing supplies, you can talk with your plan manager to discuss your individual healthcare options.
How Much Does Dexcom G6 Cost?
Dexcom G6 subscription costs about $420 per month on average for those who do not have health insurance.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover screening DEXA scans?