Medicare's Coverage of Dexcom G6

Medicare Part B covers the Dexcom G6 continuous glucose monitor for people with diabetes who meet specific medical criteria. The program pays for the sensor, transmitter, and receiver, though you will pay a portion of the cost through your deductible and coinsurance. The exact amount Medicare pays depends on whether you have Original Medicare or a Medicare Advantage plan, and the amount varies by supplier and region.

Medicare considers Dexcom G6 a "durable medical equipment" (DME) benefit, which means it follows the standard Part B cost-sharing rules. You pay 20 percent of the approved amount after you have met your Part B deductible ($240 in 2024, though this changes yearly). Medicare pays the remaining 80 percent to an approved DME supplier, who then ships the device to you.

Key Takeaways

  • Medicare Part B covers Dexcom G6 if your doctor prescribes it and you meet medical criteria, typically meaning you use insulin and check your blood sugar at least four times daily or use an insulin pump.
  • You pay 20 percent coinsurance after your Part B deductible; the exact dollar amount depends on the supplier's approved price in your area.
  • Medicare Advantage plans cover Dexcom G6 but may charge different copays or coinsurance amounts, so you should check your plan documents or call your plan directly.
  • You must order through a Medicare-approved DME supplier; ordering directly from Dexcom or using a non-approved supplier means Medicare will not pay.
  • Sensors last 10 days and transmitters last 90 days, so your ongoing costs repeat on that schedule unless your plan caps annual spending.

Medical Requirements Medicare Uses

Medicare does not cover Dexcom G6 for everyone with diabetes. You must meet at least one of these conditions: you take insulin multiple times daily and check your blood sugar at least four times per day, or you use an insulin pump. If you manage your diabetes with oral medication alone, Medicare will not pay for the device.

Your doctor must write a prescription that states you meet one of these criteria. The DME supplier will ask for this prescription before processing your order. If your prescription does not clearly document the medical need, the supplier may ask your doctor for more detail or may deny the order outright.

If you have had a recent change in your diabetes treatment — for example, you just started insulin — your doctor's prescription should reflect that change. Prescriptions older than one year may be questioned by the supplier, so ask your doctor to write a current one if yours is dated further back.

What You Pay Out of Pocket

Your out-of-pocket cost has two parts: your Part B deductible and your coinsurance. The Part B deductible is $240 per year (2024), and you pay this once per calendar year before Medicare begins to pay its share. After you meet the deductible, Medicare pays 80 percent of the approved amount and you pay 20 percent.

The approved amount varies by region and supplier. In some areas, the approved amount for a month's supply of Dexcom G6 sensors and transmitter is around $300 to $350; in others it may be higher or lower. Your 20 percent coinsurance would then be roughly $60 to $70 per month, though this is not a fixed number.

If you have a Medicare Advantage plan, your costs may be different. Some plans charge a flat copay per sensor (for example, $35 or $50), while others use coinsurance like Original Medicare. A few plans may cover Dexcom G6 with no copay at all. You should call your plan's customer service number to ask what you will pay before you order.

How to Order Through Medicare

You cannot order Dexcom G6 directly from Dexcom and have Medicare pay. You must use a Medicare-approved DME supplier. Dexcom maintains a list of approved suppliers on its website, organized by state. You can also call Dexcom's customer service line and ask which suppliers near you accept Medicare.

Once you have chosen a supplier, contact them with your prescription. They will verify your Medicare coverage, confirm you meet the medical criteria, and calculate what you owe. They will then ship the device to your home. This process usually takes 5 to 10 business days after the supplier receives your prescription.

Keep a copy of your prescription and the supplier's order confirmation. If there are delays or billing problems, you will need these documents to follow up. Some suppliers are faster than others, so if speed matters to you, ask the supplier how long shipment typically takes before you place the order.

Refills and Ongoing Supply

Dexcom G6 sensors are designed to last 10 days, and the transmitter lasts 90 days. After 10 days, you need a new sensor; after 90 days, you need a new transmitter. You will pay coinsurance each time you receive a new supply, so your costs repeat monthly or every few months depending on how you order.

Some suppliers will set up automatic refills so sensors arrive before your current one expires. Others require you to call or place a new order each time. Ask your supplier which option they offer and whether automatic refills are the default or something you have to request.

If your Part B deductible resets on January 1st, you may want to time your first order so that you meet the deductible early in the year and then pay only coinsurance for the rest of the year. However, this is a minor consideration — do not delay starting the device if you need it.

Medicare Advantage Plan Differences

If you are enrolled in a Medicare Advantage plan (Part C), your plan covers Dexcom G6 under its own rules, not under Original Medicare's rules. Some plans cover it with low or no copay; others charge more. Some plans may require prior authorization from your doctor before approving the device.

The best way to find out what your plan covers is to call the customer service number on the back of your insurance card. Tell them you want to know the copay or coinsurance for Dexcom G6 continuous glucose monitor. Ask whether your plan requires prior authorization and which DME suppliers your plan prefers.

A few Medicare Advantage plans do not cover Dexcom G6 at all, even if you meet the medical criteria. If your plan does not cover it, you have the option to switch to Original Medicare during the annual open enrollment period (October 15 to December 7), though you would need to wait until the next calendar year to make the change.

Common Mistakes to Avoid

The most common mistake is ordering directly from Dexcom without confirming that Medicare will pay. Dexcom's website and customer service can tell you whether you are covered, but they cannot process a Medicare claim. You must go through an approved DME supplier for Medicare to pay its share.

Another mistake is not having a current prescription. Suppliers will not process an order without one, and an old prescription may be questioned. Ask your doctor to write a new prescription if yours is more than a year old or if your diabetes treatment has changed.

A third mistake is not checking your Medicare Advantage plan's coverage before ordering. If you assume Original Medicare rules explore to your plan, you may be surprised by a higher bill. Call your plan first.

Frequently Asked Questions

Does Medicare cover the Dexcom G6 app on my phone?

Medicare covers the physical sensor, transmitter, and receiver. The Dexcom app itself is free to read, but Medicare does not pay for it separately. You need a compatible smartphone to use the app, but that is your own device, not something Medicare covers.

What if I use Dexcom G6 but do not meet Medicare's medical criteria?

Medicare will not pay if you do not use insulin or do not check your blood sugar four times daily. You would pay the full cost out of pocket. Some private insurance plans or state Medicaid programs may cover it under different rules, so check your other coverage. Dexcom also offers patient information programs for people without coverage.

Can I use my Medigap or Medicaid to cover the coinsurance?

Medigap plans may cover your 20 percent coinsurance, depending on which Medigap plan you have. Medicaid does not usually pay for Medicare coinsurance, but some states have programs that do. Call your Medigap or Medicaid plan to ask what they cover for DME.

What happens if my supplier goes out of business?

If your DME supplier closes, you will need to find another Medicare-approved supplier to refill your sensors and transmitter. Your prescription remains valid, so you can take it to a new supplier. Keep a list of approved suppliers in your area so you have backup options.

Does Medicare cover the Dexcom G7 or newer models?

Medicare's coverage of newer Dexcom models changes over time. As of 2024, Medicare covers Dexcom G6. Coverage of G7 or later models may vary. Ask your doctor or DME supplier whether Medicare covers the model you want, or call Medicare directly at 1-800-MEDICARE to confirm.