What Insurance Covers Dexcom G6?

Diabetes is a chronic disease that affects millions of people worldwide. Fortunately, advances in technology have made it easier to manage diabetes. One such technology is the Dexcom G6 Continuous Glucose Monitoring (CGM) system that provides real-time blood glucose readings. The Dexcom G6 is covered by most insurance plans, but coverage varies depending on the insurance provider.

What is the Dexcom G6 CGM System?

The Dexcom G6 CGM system is a device that continuously measures glucose levels in the interstitial fluid. It consists of three components:

1. The sensor that is inserted under the skin to measure glucose levels
2. The transmitter that sends glucose readings to the receiver or the smartphone app
3. The receiver that displays glucose readings and alerts the user of high or low glucose levels

The Dexcom G6 system is a significant improvement from previous CGM systems as it requires no calibration, is accurate, and is FDA-approved for insulin dosing. It provides real-time glucose readings every five minutes, reducing the need for fingerstick glucose testing.

Which Insurance Providers Cover Dexcom G6?

The Dexcom G6 CGM system is covered by most insurance providers, including Medicare and Medicaid. However, coverage varies by provider, and some insurance plans may have specific requirements for coverage. Patients are advised to check with their insurance provider to determine their coverage.

For patients who are eligible for Medicare, the Dexcom G6 is covered under Medicare Part B. Medicare covers 80% of the cost, and the patient is responsible for the remaining 20%. However, patients must meet specific criteria to be eligible for coverage, such as having Type 1 or Type 2 diabetes and requiring frequent glucose monitoring.

Medicaid coverage for the Dexcom G6 CGM system varies by state. Patients are advised to check with their state Medicaid program to determine their eligibility and coverage.

How to Get the Dexcom G6 Covered by Insurance?

Prior authorization from the insurance provider is required to get the Dexcom G6 CGM system covered. Patients should work with their healthcare providers to complete the necessary paperwork for prior authorization. The healthcare provider will provide the insurance provider with the necessary medical information, and the insurance provider will determine coverage based on the patient’s eligibility.

If the insurance provider denies coverage for the Dexcom G6 CGM system, patients can appeal the decision. Patients should work with their healthcare providers to present additional medical information to the insurance provider to support the appeal.

Dexcom G6 CGM System FAQs

1. How often do I need to replace the Dexcom G6 sensor?

The Dexcom G6 sensor needs to be replaced every ten days.

2. Can the Dexcom G6 be used with an insulin pump?

Yes, the Dexcom G6 CGM system can be used with an insulin pump.

3. Can I take a shower or swim with the Dexcom G6?

Yes, the Dexcom G6 is waterproof and can be worn while swimming or taking a shower.

4. Does the Dexcom G6 require calibration?

No, the Dexcom G6 does not require calibration as it is factory-calibrated. However, patients are advised to perform a fingerstick glucose test if they suspect the CGM’s accuracy.

5. Can I receive alerts for high or low glucose levels on my smartphone?

Yes, patients can receive alerts for high or low glucose levels on their smartphone if they have the Dexcom G6 app installed. The app is available for both iOS and Android devices.

Conclusion

The Dexcom G6 CGM system is an essential tool for people with diabetes to manage their condition. It provides real-time glucose readings, reduces the need for fingerstick glucose testing, and is FDA-approved for insulin dosing. Most insurance providers cover the Dexcom G6, but coverage varies by provider. Patients should work with their healthcare providers to get the necessary paperwork for prior authorization and appeal if the insurance provider denies coverage.