Medicare Part B covers Dexcom G7, but you will need a prescription and meet specific requirements

Yes, Medicare Part B covers the Dexcom G7 continuous glucose monitor (CGM) as durable medical equipment. However, coverage is not automatic. Your doctor must prescribe it, and you must meet medical criteria that Medicare has set. The device itself and the sensors are covered, but you will pay your share of the cost based on your plan.

Dexcom G7 is a small sensor worn on your skin that checks your blood sugar every five minutes and sends readings to a receiver or your phone. Medicare decided in 2022 that this type of device is medically necessary for people with diabetes who use insulin, which is why it is now a covered benefit.

Key Takeaways

  • Your doctor must write a prescription for Dexcom G7 and document that you use insulin daily to treat your diabetes.
  • Medicare Part B pays 80 percent of the approved amount after you meet your yearly deductible; you pay 20 percent coinsurance.
  • You must order through a Medicare-approved supplier, not directly from Dexcom, to receive the Medicare price.
  • Sensors are typically covered once every 30 days, and the transmitter is covered once per year.
  • If you have a Medigap or Medicare Advantage plan, your out-of-pocket cost may be lower than the standard 20 percent.

Who qualifies for Medicare coverage of Dexcom G7

You must be enrolled in Medicare Part B and meet all of these conditions: you have diabetes, you use insulin at least once daily, and your doctor believes a CGM will help you manage your blood sugar. Your doctor will need to document this in your medical record and submit it to Medicare or the supplier as proof.

You do not have to be a certain age or have a certain type of diabetes. Type 1, Type 2, and gestational diabetes all count, as long as you use insulin every day. If you use insulin only at certain times or only for a short period, your doctor may still be able to make the case that a CGM is medically necessary, but Medicare will review the request.

If you have both Medicare and Medicaid (dual coverage), Medicaid rules may also explore to your coverage. Check with your state Medicaid program about whether they cover Dexcom G7 and what their rules are, because sometimes Medicaid pays first.

What you will pay out of pocket

After you meet your Part B deductible for the year, Medicare pays 80 percent of the approved amount for Dexcom G7 sensors and the transmitter. You pay the remaining 20 percent coinsurance. The approved amount varies by supplier and region, but as of 2024 it typically ranges from $40 to $60 per sensor.

If you have a Medigap plan (supplemental insurance), it may cover some or all of your 20 percent coinsurance, depending on which plan you have. If you have a Medicare Advantage plan, your costs depend on your specific plan's rules — some charge a copay per sensor instead of coinsurance, and some may have different deductibles. Call your plan to find out your exact cost before you order.

You will need to order through a Medicare-approved supplier to get the Medicare price. If you order directly from Dexcom's website or call their customer service line, you will likely pay the full retail price, which is much higher. Ask your doctor which suppliers they recommend, or search the Medicare supplier directory online.

How to order Dexcom G7 through Medicare

First, talk to your doctor about whether Dexcom G7 is right for you. Your doctor will write a prescription that includes your diagnosis, your insulin regimen, and the medical reason you need a CGM. Bring this prescription to a Medicare-approved Dexcom supplier or ask your doctor's office to send it directly.

Contact the supplier by phone or online and give them your Medicare number, your prescription, and your doctor's contact information. The supplier will verify your coverage with Medicare and tell you what your out-of-pocket cost will be. They will then ship the starter kit to your home, usually within a few business days.

After your first sensor, you will need to reorder every 30 days. Most suppliers will set up automatic refills so you do not run out. You can also call or order online each time. The transmitter (the small device that holds the sensor) is covered once per year, so you will not need to reorder it as often.

What happens if Medicare denies your request

If Medicare or your supplier tells you that your request was denied, ask for the reason in writing. Common reasons include: your doctor did not document that you use insulin daily, your prescription was incomplete, or the supplier submitted the paperwork incorrectly. Many denials can be fixed by resubmitting with the missing information.

You have the right to appeal a denial. Ask your supplier or your doctor's office to help you file an appeal with Medicare. Include a letter from your doctor explaining why you need the device and any additional medical records that support your case. The appeal process takes time — usually several weeks — but many people succeed on appeal.

If you are denied and cannot afford to buy Dexcom G7 out of pocket, ask Dexcom about their patient information program. They offer discounts or free devices to people who meet income requirements, even if Medicare does not cover them.

Dexcom G7 versus other continuous glucose monitors

Medicare also covers other CGMs, including the Freestyle Libre 2 and the Medtronic Guardian. Each has different features and costs. Freestyle Libre 2 does not require fingerstick calibration like some older models, and Medtronic Guardian can connect to an insulin pump. Your doctor can prescribe whichever one they think will work best for your diabetes management.

Dexcom G7 has a 30-minute warmup time and sends alerts to your phone or receiver if your blood sugar is too high or too low. Some people prefer it because the alerts are customizable and the sensor lasts 10.5 days. Others prefer Freestyle Libre because it does not require a separate receiver. Ask your doctor and your supplier about the differences so you can choose the device that fits your life.

If you switch from one CGM to another, you will need a new prescription from your doctor. Medicare will cover the new device as long as you still meet the requirements. Some suppliers can help coordinate the switch so you do not have a gap in coverage.

Frequently Asked Questions

Do I need to use a specific supplier to get Medicare coverage?

Yes, you must order through a Medicare-approved supplier. Your doctor can tell you which suppliers are approved in your area, or you can search the Medicare supplier directory on Medicare.gov. If you order directly from Dexcom or a non-approved supplier, Medicare will not pay, and you will owe the full retail price.

Will Medicare cover replacement sensors if I lose or damage one?

Medicare covers one sensor per 30 days as scheduled. If you lose or damage a sensor before 30 days have passed, you will have to pay out of pocket for a replacement, or ask your supplier if they have a replacement program. Some suppliers will replace one damaged sensor per year at no extra cost, but this varies. Call your supplier to ask about their policy.

What if I am on Medicare Advantage instead of Original Medicare?

Medicare Advantage plans must cover Dexcom G7 if you meet the medical requirements, but your out-of-pocket cost and the suppliers you can use may be different. Call your plan's customer service number to find out your copay or coinsurance, which suppliers are in-network, and whether you need prior approval from your plan before ordering.

Can I use Dexcom G7 with my insulin pump?

Dexcom G7 can send readings to certain insulin pumps, including Tandem and Omnipod systems, so the pump can adjust insulin automatically based on your blood sugar. Medicare covers both the CGM and the pump separately. Ask your doctor and your pump supplier whether your specific pump model is compatible with Dexcom G7.

Do I have to pay for the Dexcom app on my phone?

No. The Dexcom app is free to read and use. You do not need to pay a subscription fee to receive readings on your phone. Medicare covers the sensor and transmitter only, not any apps or software, but Dexcom provides the app at no cost to all users.