Does Medicare Cover Dexcom G6? 

Diabetes is a condition that affects about 37 million people in the United States, a figure that is made up of individuals from all walks of life and all demographics. Although diabetes can affect people at any age, it tends to have the largest effect on the senior population. It’s important to test blood glucose levels and manage diabetes symptoms regularly, so Medicare recipients likely worry about the cost of their glucose monitors.

Why is blood glucose important for diabetics?

In a person with diabetes, complex systems involving the pancreas, insulin production and blood glucose are all intertwined. Type II diabetes is common in individuals who experience trouble producing enough insulin as well as trouble with processing insulin. Because insulin is used to regulate blood glucose, type II diabetes can mean that a diabetic has too much glucose in their blood, potentially leading to nervous system disorders and organ damage.

How is blood glucose monitored?

Traditionally, blood glucose has been monitored using a finger-stick method. This method requires a person with diabetes to puncture the skin, typically on the tip of the finger, to draw out a droplet of blood. This droplet is then collected onto the end of a test strip that is inserted into a reading device.

While this method is fairly accurate and fast, it is inconvenient. Not only do diabetics need to undergo the painful process of collecting blood, but they also need to adhere to a testing schedule. To solve these challenges, continuous glucose monitoring (CGM) devices like the Dexcom G6 are now used to continually check glucose levels throughout the day and night.

What is the Dexcom G6?

The Dexcom G6 is a CGM product produced by Dexcom. It features a wearable sensor that checks blood glucose levels every five minutes and wirelessly transmits results to a receiver and a smartphone app that the user can check. If levels are outside of an acceptable range, the user can be alerted so that the appropriate action can be taken. Using the Dexcom G6 means that diabetics no longer need to engage in finger sticks to draw blood for testing, and the sensor can be worn for up to 10 days before it will need to be replaced.

Does Medicare cover the Dexcom G6?

Original Medicare coverage for diabetics includes some coverage for traditional clinical testing as well as at-home testing supplies, but the program also supplies coverage for the Dexcom G6 in most cases. In order to qualify, most Medicare recipients will need to have been diagnosed with either type I or type II diabetes, have a medical need for continuous glucose monitoring, see their doctor at least once every six months for follow-up and have a need for at least three daily insulin treatments.

If conditions have been met, Medicare Part B supplies coverage for the Dexcom G6 system. This includes the cost of the monitoring device, the use of the monitoring app as well as coverage for the sensors that the system uses to monitor glucose levels. Medicare coverage under Part B typically covers 80% of the cost of the Dexcom G6 once a Medicare recipient’s deductible has been met for the benefit period.

Dexcom G6 Medicare coverage is available through suppliers that have been approved by Medicare. Dexcom states that coverage is only available if Medicare recipients have access to a receiver that is compatible with the Dexcom G6. Coverage is not available if you plan to use a smartphone only to monitor glucose levels.

For more information, contact your Medicare benefits plan provider or reach out to Dexcom directly to learn about the company’s policies.