Does Medicare Part B Cover the Dexcom G7 Continuous Glucose Monitor?

Medicare Part B Coverage for Dexcom G7

Yes, Medicare Part B covers the Dexcom G7 continuous glucose monitor, but only if you meet specific medical requirements and follow the correct ordering process. The device is covered as durable medical equipment (DME), which means Medicare will pay 80 percent of the approved amount after you meet your Part B deductible. You pay the remaining 20 percent.

The key requirement is that your doctor must prescribe the G7 as medically necessary for your diabetes management. Medicare does not cover it for all people with diabetes — only for those whose condition meets their clinical criteria. The prescription must come from your treating physician and be submitted through a Medicare-approved DME supplier, not directly from Dexcom.

The approval process typically takes one to two weeks once your doctor's order reaches the supplier. During that time, the supplier verifies your Medicare coverage and confirms that your prescription meets Medicare's requirements. If everything is in order, the supplier ships the G7 sensors to your home.

Key Takeaways

• Medicare Part B covers Dexcom G7 as durable medical equipment, paying 80 percent of the approved amount after your deductible is met.
• Your doctor must write a prescription stating the G7 is medically necessary, and it must be submitted through a Medicare-approved DME supplier, not ordered directly from Dexcom.
• Medicare covers the sensors and transmitter but not the receiver or charging cable, which you may need to purchase separately.
• You will need to recertify your prescription every 12 months, and your doctor must resubmit the order to continue receiving sensors.
• If your claim is denied, you have the right to appeal through Medicare's standard appeals process within 120 days of the denial notice.

Medical Requirements Medicare Uses to Approve Dexcom G7

Medicare covers the Dexcom G7 only for people with insulin-dependent diabetes who meet one of two conditions. The first is that you are currently using insulin and checking your blood sugar at least four times per day. The second is that you have a history of severe hypoglycemia (dangerously low blood sugar) or hypoglycemic unawareness, meaning you do not feel the symptoms of low blood sugar coming on.

Your doctor determines whether you meet these criteria based on your medical history and current treatment plan. The prescription itself is the document that confirms your doctor believes the G7 is medically necessary for you. Medicare does not require you to submit a separate form to prove you meet the criteria — the prescription from your doctor serves as that proof.

If you use insulin but do not check your blood sugar four times daily, or if you do not have a history of severe lows, your prescription may be denied. In that case, you can ask your doctor to document why the G7 is still necessary for your specific situation and resubmit the order with additional clinical notes.

How to Order Dexcom G7 Through Medicare

The first step is to talk to your doctor about whether the Dexcom G7 is right for you. If your doctor agrees it is medically necessary, ask them to write a prescription. The prescription should specify "Dexcom G7" and state that it is for continuous glucose monitoring.

Your doctor will send the prescription to a Medicare-approved DME supplier. You can ask your doctor which supplier they work with, or you can find one yourself by searching Medicare's DME supplier directory on Medicare.gov. Some suppliers specialize in diabetes equipment and may be more familiar with the approval process.

Once the supplier receives your prescription, they will contact you to verify your Medicare information and confirm your address. They will also check whether your prescription meets Medicare's requirements. If there are any issues, the supplier will contact your doctor to clarify or request additional information.

After approval, the supplier ships the G7 sensors to your home. The first shipment usually arrives within one to two weeks. Ongoing shipments are typically sent every three months, depending on how many sensors you use per month.

What Medicare Pays and What You Pay Out of Pocket

Medicare's payment for Dexcom G7 is based on the Medicare-approved amount, not Dexcom's retail price. The approved amount varies by region and supplier but is typically lower than what you would pay if you bought the device without insurance. Medicare pays 80 percent of this approved amount; you pay 20 percent.

Your Part B deductible applies to the Dexcom G7 just as it does to other DME. In 2024, the Part B deductible is $240 per year. Once you have paid $240 out of pocket toward your deductible, Medicare begins paying its 80 percent share. Until then, you pay 100 percent of the cost.

If you have a Medigap or Medicare Advantage plan, your supplemental coverage may help pay your 20 percent coinsurance or your deductible. Check your plan documents or call your plan to see what they cover for DME.

Medicare does not cover the receiver device or charging cable. Some people use the G7 with a smartphone app instead of a receiver, which means you do not need to buy a separate receiver. If you do want a receiver, you will need to purchase it out of pocket, usually for $30 to $50.

Recertification and Ongoing Coverage

Your Dexcom G7 prescription is valid for 12 months from the date your doctor writes it. After 12 months, your doctor must write a new prescription for you to continue receiving sensors through Medicare. This is called recertification.

About one month before your prescription expires, contact your doctor's office to request a new prescription. Your doctor will review your diabetes management and decide whether the G7 is still medically necessary. In most cases, if you have been using it successfully, your doctor will renew the prescription without difficulty.

Once your doctor writes the new prescription, send it to your DME supplier. The supplier will resubmit it to Medicare for approval. There is usually no gap in your sensor shipments if you request the new prescription on time, but delays can happen if your doctor is slow to respond or if Medicare needs additional information.

What to Do If Medicare Denies Your Claim

If your DME supplier tells you that Medicare denied your prescription, you will receive a formal denial notice in the mail. This notice explains why Medicare denied the claim and tells you how to appeal. You have 120 days from the date of the denial to file an appeal.

The first step in appealing is to contact your supplier and ask them to resubmit the claim with additional information from your doctor. Sometimes a denial happens because the supplier did not include enough clinical detail in the original order. Your doctor can write a letter explaining why the G7 is medically necessary for you, and the supplier can resubmit with that letter attached.

If the resubmission is also denied, you can file a formal appeal with Medicare. You will need to submit your appeal in writing, along with any supporting documents from your doctor. Medicare will review your case and send you a decision within 30 days. If you disagree with that decision, you can request a hearing before a Medicare administrative law judge.

Dexcom G7 Versus Other Continuous Glucose Monitors Under Medicare

Medicare also covers other continuous glucose monitors, including the Freestyle Libre 2 and the Medtronic Guardian. Each device has slightly different Medicare coverage rules and approved amounts. Your doctor can prescribe whichever device they believe is best for your medical needs.

The Freestyle Libre 2 has similar coverage to the Dexcom G7 but does not require a separate transmitter — the sensor itself contains all the electronics. The Medtronic Guardian is covered for people who meet additional criteria related to hypoglycemia risk. If your doctor prescribes one device and Medicare denies it, you can ask your doctor whether a different device might be covered instead.

The choice between devices often comes down to personal preference, accuracy, wear time, and how well each one integrates with your phone or other devices. Talk to your doctor about which option fits your lifestyle and diabetes management goals.

Frequently Asked Questions

Do I need to use a Medicare-approved supplier, or can I order directly from Dexcom?

You must order through a Medicare-approved DME supplier. If you order directly from Dexcom, Medicare will not pay for it, even if you have a valid prescription. The supplier is the middleman who handles the Medicare paperwork and billing.

What happens if I switch to a different DME supplier?

You can switch suppliers at any time. Contact your new supplier with your current prescription, and they will resubmit it to Medicare. There may be a brief delay in your next sensor shipment while the new supplier processes your order, so plan ahead if possible.

Will Medicare cover Dexcom G7 if I use a pump but not insulin injections?

Yes. If you use an insulin pump, you are considered insulin-dependent, and Medicare will cover the G7 if you also meet the blood sugar monitoring requirement (checking at least four times daily) or have a history of severe hypoglycemia.

Can I appeal if my doctor says I do not meet Medicare's criteria?

If your doctor does not believe the G7 is medically necessary for you, Medicare will not cover it. You cannot appeal a denial based on your doctor's clinical judgment. However, you can seek a second opinion from another endocrinologist or diabetes specialist.

Do I have to pay anything upfront before Medicare approves my claim?

No. Once your prescription is submitted through a Medicare-approved supplier, you should not have to pay anything until after Medicare makes a coverage decision. If the supplier asks you to pay upfront, contact Medicare to report it.