Going on 6 years of my pharmacy and medical coverage both having specific exclusions to get out of covering CGMs, and the OOP costs just keep going up.
I paid $179 for 3 Dexcom G6 sensors in January (stretched out use by restarting), got a trial freebie Libre 3+ in March, and have been mostly without any monitoring (save finger sticks) since. Truly don’t know what to try next, and doctor’s office and both insurance companies are no help at all. I’m not entirely sure what’s on the market/what’s going to be discontinued this year?
@Pianoplayer7008 I echo the welcome back of @Eric. Sorry your facing the issue and wish I could advise, but I’ve also only used Dexcom G6/7 and Omnipod Dash, and I don’t have the issue of OOP. Any chance of changing the insurance you have? To something covers at least part of the cost CGM? Do they cover test strips/testers? Hopefully, others here can provide better support than I can.
Back about 10 years ago I was in the same boat while I appealed the coverage with my insurer. Dexcom sold me a package at a decent discount…my recollection was if I bought 6 months of sensors the receiver and transmitters were free. (Or something like that.) No idea if they still do discounts for cash payers but it is worth asking each of the companies.
To answer your question, it seems to me that Dexcom G6 would be the most cost effective because (a) it can be restarted and maybe get more days out of each sensor, plus replacements for every sensor that does not go a full 10 days and (b) as more people switch to G7 there might be surplus G6 sensors and transmitters for sale around the internet.
In case you are appealing the coverage with your insurance, don’t give up. What finally won my appeal was review of the coverage policy by the insurer (every insurer has these in writing), submittal of an appeal letter referenced to that policy, and constant phone calls until I finally found some people at the insurer who would read the letter and respond to tell me what additional documentation they wanted to see.
Thank you, @Eric and @TomH! You’re both reinforcing my love of the Dexcom G6, which I did (unknowingly; long story) pay OOP for from Jan-Sep of last year. And TomH, my pharmacy insurance asked me the same thing, but since I’m only part-time (self) employed, we’re dependent on whatever insurance my husband’s work chooses.
@John58, this is helpful - thank you. I’m about to start working on the appeal process, and it’s at least nice to know persistence paid off for you. Sometimes I get weary of all of the back and forth.
I paid $1094.52 on March 13 2025 for a 90 day supply of G7s, so 9 sensors. That’s $364.84 for three. Assuming you are in the US and using insurance you are doing pretty good.
Forget the “free trials” (you pay with your data which is very very valuable to the manufacturers). The base price for any single item for someone with a disability is $300/month.
This is why when we look for insurance policies, or jobs, we must consider the OOP max. That is what we will pay; that’s it. Forget what one or other thing costs, it’s the OOPMax that matters.
Not just us. Everyone; disabled or not! When something bad happens we pay the Out Of Pocket Maximum and, before the ACA, for most people that meant we went bankrupt. IRC my OOPMax before the ACA with Oregon’s backstop BCBS covered plan was $30,000. The same for my wife. Crash my car pay $60,000 and no car.
If I wanted Dexcom CGMs without insurance I’d buy a ticket (not first class; last time I thought about that it was $10,000) and buy them somewhere else then illegally smuggle them into the US (where they are a prescription item, so can’t be imported without a license). Well, no, I wouldn’t do that; I don’t break the law. I just wouldn’t come back.
GoodRX shows a price of $189 for 3 G7 sensors (so $64 each). (GoodRX is an amazing way to get much better prices on prescriptions from your local pharmacy. I used it all the time when I was on a high-deductible insurance plan.)
I currently have an $11 copay for each sensor through my health insurance.
If I was facing this question, I think I would pay the higher price vs not using a CGM.
It’s $188.62 for three G7s ATM for a member mail order. I might try them but it’s not clear whether or not they are contracted with Medicare for CGMs. Cost for me on Part B is $0 because of my MediGap policy. (Why do these names sound like fish that live where the sun doesn’t shine?)
GoodRx is showing CostCo at $179.03 “Dexcom G7 1 sensor (3 cartons).” ATM Alberstons (Sav-on) and Safeway are coming out ahead at $172.52.
I.e. the going price is $60/sensor, $180/month and no one is charging any different… unless you have insurance…
WalMart is currently trying to charge me $1412.28 for a 3 month (9 sensor) supply; $470.26 for three, whereas on GoodRx they are at $187.52 for three. In both cases this is the “MediCare” price. I talked to WalMart as to why they didn’t bill MediCare and a very nice lady told me that MediCare Part B does not cover CGMs, when I started to read the actual text from the official US government book I just received she hanged up.
So it’s $6/day without US insurance; $1,000/year but you won’t get that price if you don’t have a lot of money to waste.
Costco is quite nice to work with. I don’t think they deal with Part B though. I bought a Dexcom transmitter through them years ago when Dexcom had a deal going so I would have a back up. It turned out free. But I asked and at that time they said no. The policy could have changed, I don’t have a clue!
Interesting enough if you are a member they have a drug program to supply items at a cheaper cost if you don’t have insurance or your insurance co pay is high. I’ve used the program in the past for very expensive veterinary medication. I get my Libre’s through them because they are not covered by insurance as it already is covering my Dexcom CGM’s. ( I wear both when I swim).
Dexcom’s Stelo and Libre’s Lingo and Libre Rio have the benefit of not needing a prescription and it looks like you can get 2 Stelo’s for around $80-85 or $90 from Dexcom. Interesting enough I thought the Abbot’s Lingo was going to be cheaper than their regular Libre’s, but it looks like they are around $90 for 2 or $250 for 6. Pretty close to the same price. It makes sense as the hardware and housing are supposed to be the same as LIbre 3, just the software application is different.
I think the Lingo has the same housing as the Libre 2. Maybe the rio is the 3 housing? I don’t believe that one has been released.
Amazon seems to have the best price on Stelo at the moment. 70 bucks for 2 if you subscribe. I tried Stelo before I switched my script to the G7. It has the same accuracy as the G7 for me but a high failure rate.
I’m still working through this; at this point Albertson’s say they will handle the Dexcom under Part B whereas Walmart flat out denied that the G7 is covered under Part B, “It [the G7] is not covered under Part B” to quote the nice lady.
Medicare, however, offer this web page:
If you look at the “drop-down” for “Equipment (optional)” (i.e. using the drop down is optional) there are two entries for CGMs:
Having spent some time with Medicare on the 'phone two days ago I eventually discovered that “Blood Glucose Monitors and Supplis (Non-Mail Order)” are uniquely items that a Medicare Part B supplier can decline to supply. In fact it seems that it’s an “opt in”.
The search on that page gives a convenient map so I searched in 97504 (my closest CostCo) and yep, they aren’t there. I double checked and, yep, they don’t do Part B, at least not in Medford.
Despite this a vast number of the usual suspects do claim to supply “non-mail order” blood glucose monitors. This includes the Walmart I tried (97526).
We live in the post truth world.
EDIT: irrelevant but most likely the apologists will claim this to refute my argument. The actual map on Medicare.gov is way out of date, 10 years I think; for 97526 it identifies Walmart in the wrong place (I think the actual location was probably built more like 30 years ago), Albertsons as close to Walmart (they shut that location down then sold it to Harbor Freight maybe 10 years ago) and also fingers Rite-Aid in the south (sold to Walgreens a few years back) and lists Albertson’s (in the correct location) as “Sav-On”; that name doesn’t appear anywhere because it’s still known as “Albertsons” round here. (It’s part of another spelling glitch; Supervalu.)
Local pharmacies seem to be adverse to Medicare part B. They want to use Part D for everything. My policy requires that I use DME companies for Dexcom, Pump supplies and urostomy supplies.. My only complaint is I have 3 different DME suppliers. I tried to consolidate Dexcom and pump supplies with CCS Med as they are easier to deal with. The problem is that my insurance company doesn’t allow 90 day supplies for Dexcom, while the other DME does. I gave up.
I’ve been impressed by Edwards (mail order) for Dexcom DME supplies on Medicare part B. Back when I had private insurance I tried a few of the well known DME suppliers and I tried a few local pharmacies even though my insurer covered it as DME. Edwards seems to be the only one with knowledgeable people answering the phone… When I started on Medicare there were no hiccups.
1-888-344-3434 in case you want to give Edwards a try
That’s why I opted to go for “old” Medicare; i.e. Part A, Part B (optional but not that optional) and Part D (optional); not Part C (“Medicare Advantage”).
It was completely clear that I would pay at least as much on Part C as I did on the ACA; the base prices were about the same but I couldn’t use an HSA to pay other costs before tax.
On Part B every provider has to provide the same way; i.e. there is no insurer to force me to use his buddies for stuff. This also applies with a “MediGap” policy (I talked to my MediGap insurer a couple of days ago on this very matter and was told they don’t and can’t control what provider I use and have no preferences
This is in contrast to Part D (which does not cover CGMs or most pumps but does cover my Omnipods). I had to carefully pick a Part D provider that covered the Dash pods; this could turn into a disaster next year as Cigna (said provider) has just got taken over by some mega company.
The one black spot in the logical Part B coverage (it’s “part B” or it isn’t) is that “Blood Glucose Monitors (non-mail order)” are a separate class and a part B supplier may opt out.
I don’t know how the Part C guys are doing this; Medicare stuff is either A, B or D. Under some circumstances Part D items are Part B (when prescribed in-patient), but unless someone can show me evidence in the Medicare rules it’s unambiguous in all cases apart from that.
CGMs require a compliance statement from the prescriber (i.e. your endo) and the provider (Albertsons, EdgePark etc) are in violation of the law if they do not have that statement before they deliver the CGM to us. Pretty damn clear. Of course if you have several city blocks full of lawyers you can do anything you want on 5th avenue…
@jbowler I would like to add that I have been pleasantly surprised that I have had no co-pays on Dexcom and Tandem supplies. I do have for my urostomy supllies. I hope the lack of co-pays continues. All are mail order 90 days for CGM and Sets, 30 days for the urostomy supplies. The later is a plus because I don’t know where I would keep 90 days worth of that stuff.
It seems that people on Part C (Medicare Advantage Plans) see a completely and utterly different set of rules and payments. I just got told by Albertsons (Savon) that they aren’t contracted with Medicare (Part B) for the Dexcom G7 but that they can fill it for a Part C (Medicare Advantage) customer.
The basic Part B has a fixed deductible of $257 then covers everything at 80% of the approved cost. With a Medicare supplement (“Medigap”) Plan G or (assuming you were born before 1955) Plan F the supplement covers the remaining 20% so the total payments for the year for all of Part B should end up at $257 plus the $185x12 monthly premium.
The catch with medical equipment seems to be that a contracted provider can charge more. Here’s the magic search on medicare.gov for all ostomy suppliers (well, the ones near me; just change the zip code to yours):
Ok, but look down that list for the note on just two of the suppliers that they “charge the Medicare approved amount”. The good thing is that we can search for that too, go to the top of the page and look for the “Medicare-approved payment” box:
Notice that the number of suppliers drops from 5 to just 2
That’s a great page so far as it goes. For me, however, it doesn’t distinguish between the “blood glucose monitors and supplies” sub-items and it seems that the pharmacies are opting out of supplying the Dexcom G7 possibly because of the requirement that they get the compliance statement from the doc.
