Managing diabetes requires constant monitoring of blood sugar levels, which can be burdensome and uncomfortable. Many people with diabetes prick their fingers and use a blood glucose meter (BGM) to check their levels, unaware that continuous glucose monitors (CGMs) offer a more effective solution to monitoring low blood sugar.
The Dexcom CGM systems are popular due to their advanced features. However, concerns about affordability often arise, especially for individuals on Medicare.
This article will delve into Medicare’s coverage of continuous glucose monitoring systems, like the Dexcom G6 and G7, exploring eligibility criteria, recent updates, and additional Medicare beneficiary considerations.
Key Takeaways
- Medicare covers continuous glucose monitors (CGMs) under Part B durable medical equipment (DME), including Dexcom CGMs, as long as the patient meets the qualifications.
- As of July 2021, a blood sugar log is no longer required to qualify for a CGM.
- Medicare Advantage plans also cover a Dexcom CGMs, but out-of-pocket costs will vary.
- Medigap policies cover out-of-pocket costs up to the policy’s limits once Medicare has paid its share.
What are The Dexcom G6 and G7?
The Dexcom, Inc produces several continuous glucose monitoring systems, including the G6 and G71Dexcom.com, “Dexcom Continuous Glucose Monitoring“, Accessed January 8, 2023. A continuous glucose monitor (CGM) is an FDA-approved system that tracks glucose data day and night. It collects readings automatically every 5 to 15 minutes. A CGM can help detect trends and patterns that give you and your doctor a more complete picture of your diabetes. The data can help you find ways to better manage your condition.2niddk.nih.gov, “Continuous Glucose Monitoring“, Accessed December 8, 2024
In addition to the normal CGM functions, the Dexcom G6 and G7 continuous glucose monitoring systems are smartphone compatible. This allows you to monitor and record your blood sugar levels through the Dexcom phone app instead of carrying around a separate CGM device everywhere.1Dexcom.com, “Dexcom Continuous Glucose Monitoring“, Accessed December 8, 2021
How Much Do Continuous Glucose Monitors Cost?
While CGMs are more convenient and consistent than glucose monitor sticks, they are considerably more costly. Generic CGM supplies can cost over $100 a month if you do not have coverage.3uabmedicine.org, “All About Continuous Glucose Monitors for People with Diabetes“, Accessed December 8, 2021
Costs for Dexcom G6 and other CGM name brand supplies can cost even more without coverage, over $1,200 for a 90-day supply of Dexcom G6 sensors. Thankfully, most big-name pharmacies provide vouchers and discounts for CGM supplies purchased in their stores, including Dexcom G6.4goodrx.com, “Dexcom G6“, Accessed December 8, 2021
Medicare Coverage For Continuous Glucose Monitors
Effective April 16, 2023, the Centers for Medicare and Medicaid Services (CMS) has expanded coverage of CGMs to more people with diabetes.6CMS.gov, “Glucose Monitoring“, Accessed February, 2024
The Dexcom G6 and G7 CGMs are two of several systems covered by Medicare for patients who meet the Medicare coverage criteria. Medicare coverage for therapeutic CGM includes certain beneficiaries who have either type 1 or type 2 diabetes and intensively manage their insulin.5Medicare.gov, “Therapeutic continuous glucose monitors“, Accessed December 8, 2021
Medicare patients with type 1 and type 2 diabetes on intensive insulin therapy may be able to obtain reimbursement if the following Medicare coverage criteria are met:6CMS.gov, “Glucose Monitoring“, Accessed February, 2024
- The beneficiary has diabetes mellitus; and,
- The beneficiary’s treating practitioner has concluded that the beneficiary (or beneficiary’s caregiver) has sufficient training using the CGM prescribed as evidenced by providing a prescription; and,
- The CGM is prescribed per its FDA indications for use; and,
- The beneficiary for whom a CGM is being prescribed to improve glycemic control and meets at least one of the following criteria:
- The beneficiary is insulin-treated; or,
- The beneficiary has a history of problematic hypoglycemia with documentation of at least one of the following:
- Recurrent (more than one) level 2 hypoglycemic events (glucose <54mg/dL (3.0mmol/L)) that persist despite multiple (more than one) attempts to adjust medication(s) and/or modify the diabetes treatment plan; or,
- A history of one level 3 hypoglycemic event (glucose <54mg/dL (3.0mmol/L)) characterized by altered mental and/or physical state requiring third-party assistance for treatment of hypoglycemia.
- Within six months before ordering the CGM, the treating practitioner has an in-person or Medicare-approved telehealth visit with the beneficiary to evaluate their diabetes control and has determined that criteria (1)-(4) above are met.
As of July 2021, patients are no longer required to provide a “blood sugar log” with multiple daily glucose monitor stick readings to qualify for CGM coverage. This includes coverage for the Dexcom G6 and G7.6CMS.gov, “Glucose Monitoring“, Accessed December 8, 2021
To qualify for Medicare coverage of your Dexcom supplies, you must use a Dexcom receiver, even if you also use a compatible smart device. Medicare doesn’t cover Dexcom supplies that are only used with a smartphone or other mobile device. For a list of compatible smart devices, visit dexcom.com/compatibility.
Medicare Advantage Coverage
Medicare Advantage plans must cover any services and services that are also covered by Original Medicare (Part A and Part B ). This includes CGMs such as Dexcom G6 and G7. However, you will be required to receive their CGM through an in-network medical equipment supplier. Your out-of-pocket costs with a Medicare Advantage plan can also differ from Original Medicare’s costs for the same service.7Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed December 8, 2021
Medigap Coverage
Medicare Supplement Insurance (Medigap) cover some or all of the out-of-pocket costs associated with Medicare-approved CGMs and supplies. These out-of-pocket costs include:8Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?“, Accessed December 8, 2021
- Deductibles
- Coinsurance
- Copayments
Dexcom G6 vs. G7
Dexcom G6 and G7 are two generations of continuous glucose monitoring (CGM) systems developed by Dexcom, Inc. Here are the key differences:
- Size and Design: Dexcom G7 is notably smaller and thinner than the G6. The small size makes G7 more discreet and comfortable to wear. G7 also has a redesigned applicator for easier and more intuitive sensor insertion.
- Extended Wear: Dexcom G7 supports extended wear. While G6 sensors typically last about 10 days, G7 sensors are last up to 14 days.
- No Calibration: The Dexcom G7 is factory-calibrated, eliminating the need for users to perform manual calibrations with fingerstick blood glucose readings. This simplifies the user experience and reduces the need for frequent calibration.
- Integration with Smart Devices: Both G6 and G7 are compatible with smartphone apps for real-time glucose monitoring and data management. However, Dexcom G7 has improved connectivity features. It is also compatible with a wider range of smart devices.
Overall, Dexcom G7 represents a huge advancement in CGM technology. It offer a smaller design, extended wear duration, and factory calibration compared to G6. Features and functionalities vary, and users should consult with their healthcare providers for the most accurate and up-to-date information.
Dexcom G6 and G7 vs. Leading Continuous Glucose Monitors
Continuous glucose monitoring (CGM) technology has seen significant advancements in recent years, offering Medicare patients with diabetes more choices than ever before. Among the top competitors to Dexcom G6 and G7 are the FreeStyle Libre, Medtronic Guardian Sensor 3, and Abbott FreeStyle Libre 2. Each of these CGMs has its own unique features and benefits.
Dexcom G6 and G7 stand out for their accuracy and reliability in glucose monitoring. It updates readings every five minutes without the need for fingerstick calibrations. And, its integration with smartphone apps offers easy data tracking and analysis. In short, the Dexcom G6 empowers users to make informed decisions about their diabetes management in real-time.
In comparison, the FreeStyle Libre offers users a sensor worn on the back of the upper arm. The sensor provides glucose readings with a simple scan of the sensor using a reader or smartphone. While it lacks the continuous monitoring feature of Dexcom G6 and G7, it offers convenience and discretion in glucose monitoring.
The Medtronic Guardian Sensor 3 boasts advanced predictive algorithms that alert users of impending hypoglycemia or hyperglycemia up to 60 minutes in advance. This offers the user the valuable time to needed to take corrective action. Its integration with insulin pump systems offers users a comprehensive diabetes management solution.
Similarly, the Abbott FreeStyle Libre 2 offers users the convenience of factory-calibrated sensors and customizable alarms for high and low glucose levels, enhancing user experience and peace of mind. However, unlike the Dexcom G6 and G7, it requires periodic scanning to obtain glucose readings, limiting real-time monitoring capabilities.
Trends in Technology and Policy
As technology continues to evolve, the landscape of diabetes care is undergoing a transformative shift. Emerging trends are poised to revolutionize the management of this chronic condition.
One such trend is the integration of artificial intelligence (AI) and machine learning algorithms into continuous glucose monitoring. These advancements have the potential to enhance the accuracy and predictive capabilities of CGMs.
AI-driven algorithms can analyze vast amounts of data collected by CGMs to identify patterns, predict glucose trends, and provide timely interventions. Future CGMs will empower individuals with diabetes to achieve better glycemic control, reducing the risk of complications.
The rise of interconnected health ecosystems and wearable technologies is reshaping the way diabetes care is delivered and monitored. Integrated platforms that combine CGM data with other health metrics, such as physical activity, sleep patterns, and dietary intake, offer a holistic approach to diabetes management.
By leveraging data from multiple sources, healthcare providers will have deeper insights into their patients’ health status. This will allow them to tailor interventions accordingly.
This interconnectedness will help foster patient engagement and adherence to treatment. At the same time, it will facilitate remote monitoring and telehealth consultations, expanding access to specialized diabetes care, particularly in underserved communities.
In Summary
Medicare provides coverage for your continuous glucose monitoring devices, including name-brands such as Dexcom G6. Not only that, Medicare has reduced the qualifications for receiving coverage for one, so you no longer need to stab yourself in the finger four times a day to get one (fun stuff). If you are interested in knowing what other diabetic supplies are covered by Medicare, please consider reading our MedicareWire article on the topic here to find out.
Citations
- 1Dexcom.com, “Dexcom Continuous Glucose Monitoring“, Accessed December 8, 2021
- 2niddk.nih.gov, “Continuous Glucose Monitoring“, Accessed December 8, 2024
- 3uabmedicine.org, “All About Continuous Glucose Monitors for People with Diabetes“, Accessed December 8, 2021
- 4goodrx.com, “Dexcom G6“, Accessed December 8, 2021
- 6CMS.gov, “Glucose Monitoring“, Accessed December 8, 2021
- 5Medicare.gov, “Therapeutic continuous glucose monitors“, Accessed December 8, 2021
- 7Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed December 8, 2021
- 8Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?“, Accessed December 8, 2021