Medicare covers Dexcom continuous glucose monitors, but only under specific conditions
Yes, Medicare covers Dexcom continuous glucose monitors (CGMs) for people with diabetes who meet certain requirements. However, coverage is not automatic — you must have a prescription from your doctor, use insulin, and meet Medicare's medical necessity rules. The amount you pay depends on which Medicare plan you have and whether you meet your deductible.
Dexcom makes several models: the G6, G7, and G6 Pro. Medicare coverage rules are the same across these models, though your out-of-pocket cost may vary by device. Most people with Medicare Part B or a Medicare Advantage plan that includes Part B coverage can get a Dexcom, but you will need to work with your doctor and a durable medical equipment (DME) supplier to start.
Key Takeaways
- Medicare Part B covers Dexcom CGMs for people who use insulin and have a prescription from their doctor.
- You must obtain your Dexcom through a Medicare-approved DME supplier, not directly from Dexcom or a pharmacy.
- Your out-of-pocket cost is typically 20% of the approved amount after you meet your Part B deductible, unless you have a Medigap or Medicare Advantage plan that covers more.
- Dexcom sensors last 10 days and are replaced weekly, so you will need a new prescription or standing order each month to keep your supply.
- If your doctor says you need a Dexcom but Medicare denies coverage, you can ask your doctor to submit additional medical information or file an appeal.
Who qualifies for Medicare coverage of Dexcom
Medicare covers Dexcom for people with diabetes who use insulin at least once daily. This includes people with type 1 diabetes and people with type 2 diabetes who take insulin injections or use an insulin pump. If you take oral diabetes medications only (pills), Medicare does not cover a Dexcom.
You must also have a prescription from your doctor stating that a CGM is medically necessary for your care. Your doctor does not need to use any special form — a standard prescription that says "Dexcom" and includes your name, date, and their signature is enough. Some doctors will write a standing order that covers multiple months of sensors, which makes refills easier.
Medicare Advantage plans (Part C) may have different rules than Original Medicare. Some Advantage plans cover Dexcom the same way Part B does; others may require prior authorization or have a higher copay. Call your plan directly to ask about your specific coverage before you order.
How to order Dexcom through Medicare
You cannot order Dexcom directly from Dexcom's website or from a pharmacy and have Medicare pay. You must use a Medicare-approved DME supplier. These are medical equipment companies that have a contract with Medicare to provide devices like glucose monitors, test strips, and lancets.
Start by asking your doctor for a prescription. Then contact a DME supplier — you can find one by searching "Medicare DME supplier near me" or by asking your doctor's office which suppliers they work with. Common national DME suppliers include Byram Healthcare, Amedisys, and Lincare, but your area may have local options as well.
When you call the DME supplier, have your Medicare number and your prescription ready. The supplier will verify your coverage, explain your out-of-pocket cost, and arrange delivery. Most suppliers ship Dexcom to your home within 5 to 10 business days. If you need your first sensor quickly, ask the supplier whether they have it in stock locally.
What you will pay out of pocket
Under Original Medicare Part B, you pay 20% of the approved amount for Dexcom after you meet your annual Part B deductible. The deductible for 2024 is $240, but this amount changes each year. Once you meet the deductible, Medicare pays 80% and you pay 20% for the rest of the calendar year.
The exact dollar amount you pay depends on what Medicare approves for your area and which Dexcom model you use. Because prices vary by region and change over time, ask your DME supplier for a cost estimate before you order. They can tell you the approved amount and calculate your 20% share based on whether you have already met your deductible.
If you have a Medigap (supplemental insurance) plan, it may cover your 20% coinsurance, which would lower your cost to zero. If you have a Medicare Advantage plan, your copay or coinsurance depends on your specific plan — check your plan documents or call your plan to find out.
Keeping your supply going month to month
Dexcom sensors last 10 days each, so you will need about three sensors per month. Your prescription or standing order must cover this ongoing supply. Some doctors write a standing order that lasts 12 months and covers all the sensors you need during that time, which means you do not have to get a new prescription each month.
If your doctor wrote a one-time prescription, you will need to contact them for a new prescription each month or ask them to convert it to a standing order. Many DME suppliers can contact your doctor's office directly to request a refill, which saves you a phone call. Set a reminder to request your refill about one week before you run out of sensors.
If your doctor leaves their practice or retires, you will need a new prescription from your new doctor before the DME supplier can send more sensors. This is a common reason people run out of supplies, so update your prescription early if you know your doctor is changing.
What to do if Medicare denies coverage
Medicare may deny coverage if your prescription does not clearly state that you use insulin, if your doctor did not sign the prescription, or if there is incomplete information. When this happens, the DME supplier will send you a notice called an Explanation of Benefits (EOB) that explains the reason for the denial.
If you believe the denial is wrong, ask your doctor to submit additional information — such as a letter explaining why a CGM is medically necessary for your specific situation, or documentation of your insulin use. Your doctor can send this directly to Medicare or to the DME supplier, who will resubmit your claim.
You also have the right to file a formal appeal. The EOB will include instructions on how to appeal and the important date (usually 120 days from the date of the notice). If you need help with an appeal, you can contact your State Health Insurance information Program (SHIP), which offers free counseling about Medicare coverage disputes.
Dexcom models and what Medicare covers
Medicare covers the Dexcom G6, G7, and G6 Pro under the same rules. The G7 is the newest model and has a shorter warm-up time (30 minutes instead of 2 hours) and a longer wear time (10.5 days instead of 10 days). The G6 Pro is designed for healthcare providers to use in clinical settings, not for personal use at home.
Your doctor will specify which model to prescribe based on what they think is best for your care. If you have a preference, discuss it with your doctor — they can write the prescription for the model you want, and Medicare will cover it if you meet the other requirements. The DME supplier will order whichever model your prescription specifies.
Frequently Asked Questions
Can I use my Dexcom with an insulin pump?
Yes. If your insulin pump is compatible with Dexcom, you can connect them so the pump receives your glucose readings directly. Medicare covers both the pump and the Dexcom separately under their own rules. Your pump must be a model that Dexcom supports — ask your pump manufacturer or your doctor which models work together.
What if I have both Medicare and Medicaid?
If you have both, Medicaid is usually the primary payer and Medicare is secondary. Contact your state Medicaid program to ask about Dexcom coverage under Medicaid first. If Medicaid does not cover it or covers less than Medicare would, Medicare may pay the difference. Your DME supplier can help coordinate between the two programs.
Do I need prior authorization from Medicare before I order?
Original Medicare Part B does not require prior authorization for Dexcom if you have a valid prescription and meet the insulin requirement. However, some Medicare Advantage plans do require prior authorization. Call your plan before you order to find out whether you need approval first.
Can I get Dexcom if I use a continuous insulin infusion but not injections?
Yes. Medicare's rule is that you use insulin at least once daily — this includes insulin delivered by pump. If you use an insulin pump, you meet the requirement and can get a Dexcom with a prescription from your doctor.
What happens if I switch from Original Medicare to a Medicare Advantage plan?
Your Dexcom coverage may change because each Advantage plan has its own rules. Contact your new plan before your coverage starts to ask whether they cover Dexcom and what your out-of-pocket cost will be. If your new plan does not cover Dexcom, you may be able to switch back to Original Medicare during the annual enrollment period.