Does Medicare Cover Dexcom G7 Devices? What You Need to Know
If you have type 1 or type 2 diabetes, you may use a continuous glucose monitoring (CGM) device that allows real-time blood sugar readings with a sensor placed on your arm.
Instead of periodically sticking your finger with a lancet, rubbing the blood onto a testing strip, and having a blood glucose meter read the results, you can use a device such as the Dexcom G7 to give you your glucose levels at any time.
A CGM works with an insulin pump that delivers the insulin needed to keep your blood sugar at the desired level.
But does Medicare cover Dexcom G7 devices?
What is the Dexcom G7?
The Dexcom G7 is one of the newest continuous glucose monitoring (CGM) systems from Dexcom, available if you have a prescription.
Like the earlier Dexcom G6 version, the G7 provides real-time blood sugar readings without the need for frequent finger pricks. It sends glucose readings wirelessly to a receiver or compatible smart device like a smartwatch or tablet so you can closely monitor your blood sugar levels.
Does Medicare cover the Dexcom G7?
Medicare Part B covers therapeutic CGMs for eligible Medicare patients with diabetes mellitus, so long as they are FDA-approved. Products from Dexcom and Abbott Labs, the leaders in the CGM market, qualify. Other approved manufacturers include Medtronics (Guardian), Roche (Accu-Chek), and Sensonics (Eversense).
Healthcare professionals will recommend the best CGM system for your diabetes care. Dexcom products are a common CGM option. According to Dexcom, the G7 continuous glucose monitoring system is considered the most accurate CGM sold in the US based on its MARD (mean absolute relative difference.)
The Dexcom G7 CGM system is considered durable medical equipment (DME), which is covered by Medicare as your doctor prescribes it. You can obtain this convenient device with minimal out-of-pocket expenditure if you meet the Medicare coverage criteria.
Who is eligible for the Dexcom G7?
To qualify for Medicare coverage of a Dexcom G7, you must meet these requirements:
You have type 1 or type 2 diabetes or prediabetes
You take insulin or have a history of low blood sugar with a history of hypoglycemia
You have a prescription for testing supplies and instructions
You or your caregiver have been trained to use the CGM
You have routine in-person or telehealth visits with your doctor
The CGM is prescribed to improve glycemic control
You have been seen for diabetes management in the past 6 months
You require treatment adjustments based on glucose results
Once you’ve sought medical advice and received a treatment plan and a prescription, you can obtain your Dexcom G7 continuous glucose monitor and other diabetes supplies from a Medicare-approved supplier.
How much does the Dexcom G7 cost without insurance?
Without insurance, the cost of the Dexcom G7 system can vary.
It is important to know that the Dexcom G7 does not require a separate transmitter, as most CGMs do, and is intended to be used with a compatible smart device like a phone or watch as the receiver. (Separate receivers are available and sold separately.) What most people buy each month is a box of three sensors that last 10 days each.
Retail prices for the sensor can run $375, but many pharmacies that honor GoodRX sell them for less than $175. If you need a receiver, the cost may exceed $900 for the receiver and a month’s supply of sensors.
Medicare typically covers 80% of the allowed amount for durable medical equipment (DME), with the patient responsible for the remaining 20% plus any applicable deductibles and coinsurance.
The manufacturer has the Dexcom Savings Center with a pharmacy saving program to keep costs lower for those without insurance. They also offer a Dexcom Patient Assistance Program that helps low-income individuals get the equipment they need to manage their condition.
How does the Dexcom G7 CGM differ from the Dexcom G6?
Dexcom offers multiple continuous glucose monitoring (CGM) systems. The two latest versions are the G6 and the G7. While both systems are currently available, Dexcom plans to transition all users to the G7 and eventually discontinue the G6.
Dexcom says the G7 is the only CGM system that can predict and alert you about potential dangerous low blood sugar (hypoglycemic) events before they happen.
Both the G6 and G7 share these key features:
You don't need fingersticks, scanning, or calibration for regular use. (You'll only need these if your symptoms don't match the readings or for specific diabetes treatment decisions.)
The system sends real-time glucose readings to your display device every 5 minutes.
You can connect with popular health devices and apps, including the Apple Watch and Garmin.
You can share your glucose data with up to 10 people for remote monitoring.
The new Dexcom G7 builds on these features with several improvements:
It’s a 60% smaller, all-in-one device that's easier to use.
It has the fastest startup time of any CGM—just 30 minutes.
A 12-hour grace period when replacing sensors, makes the switch between sessions smoother.
A new, simpler mobile app works with Dexcom Clarity.
It comes with better alert options in the app for more privacy.
A smaller receiver with a brighter screen is easier to read.
Smaller plastic parts and packaging than the G6 reduce the device’s environmental impact.
Does Medicare cover Dexcom G6 and Dexcom G7?
Yes, Medicare will generally cover both the G6 and G7 Dexcom CGM devices. Eventually, Dexcom plans to get all G6 users onto the G7 devices but until the G6 is discontinued, Medicare is likely to cover both options.
How do you go about getting a Dexcom G7 system under Medicare?
Once you have a prescription for the Dexcom G7 system, your next step is to contact a Medicare-certified medical equipment provider that supplies the G7 continuous glucose monitoring system. Many pharmacies and medical suppliers will help you with the ordering process and insurance billing. They will also verify that you meet the eligibility criteria for Medicare coverage for therapeutic CGMs.
Want to learn more about Medicare coverage for diabetes supplies? Speak with one of our Medicare Advisors, who are eager to help you understand your coverage and how to get the most out of Medicare. Get in touch by calling us at (855) 900-2427 or picking a time to chat.