They are often considered durable medical equipment and can be ordered through approved durable medical equipment companies, such as Aeroflow, and at least partially paid for by Medicare or private insurers. Insurers and healthcare providers have clearly recognised the long-term benefits and cost savings of CGM devices. UnitedHealth Care used to cover all my supplies under DME, but has recently moved the entire set of CM devices to Express Scripts. More health plans are being added to the list as successful clinical trials continue and the FDA approves new real-time continuous glucose monitors.
They may have you incorrectly categorised as Type 2, or cover a different CGM such as Freestyle Libre. This is the case for Original Medicare beneficiaries, and the equipment will generally be covered under Part B, as the device will be considered durable medical equipment. Patients should contact 1-800-MEDICARE if they have any questions about Medicare coverage requirements for the Dexcom CGM. The Dexcom G6 Continuous Glucose Monitoring (CGM) System is covered by Medicare for patients who meet Medicare coverage criteria.
While this remains the case, the Centers for Medicare and Medicaid Services (CMS) has recently relaxed other Medicare coverage criteria. But I have recently heard that UHC has reached an agreement with Tandem (which is the pump I have) to cover their pump. A customer service representative will contact you to process a full insurance benefits check after reviewing your information. Medicare coverage for therapeutic CGM includes certain beneficiaries who have type 1 or type 2 diabetes and take insulin intensively.
Medicare Part A may also provide coverage if a Dexcom G6 system is administered during a stay in a skilled nursing facility or as an inpatient in a hospital, provided the equipment is considered a medical necessity. This is vital for patients who are diabetic or for patients who may be at risk of developing health conditions related to fluctuating or irregular blood glucose. When I started, my doctor had to document medical necessity - I was experiencing unconscious hypoglycemia - but to the point of passing out, but that was enough for my insurance to cover it. Medicare coverage for the Dexcom G6 device In most cases, Medicare benefits will cover the Dexcom G6 device under a fee-for-service arrangement.