Medicare Dexcom Coverage: What You Need to Know

Let's cut to the chaseeveryone's wondering the same thing: "Does Medicare cover Dexcom?"

Yes. It absolutely does. And if you're managing diabetes, especially if you're on insulin or have scary blood sugar drops, this could be a game changer. Butand this is a big butjust because it's covered doesn't mean it's automatic. There's a bit of red tape. A few boxes to check. A doctor's note here, a follow-up visit there.

I remember when my neighbor Linda finally got her Dexcom after years of finger pricks. She said it was like "finally turning on the lights in a dark house." But getting there? A little frustrating. The paperwork, the calls, the "Wait, I need a receiver?" confusion. It didn't have to be that hard.

So let's make it easier. No jargon, no fluff. Just real talk between friends. Whether you're new to CGMs or you've been eyeing the Dexcom G7 for months, I'll walk you through everything: who qualifies, how much it costs, and how to actually get it coveredwithout surprise bills.

Who Qualifies?

First things first: you can't just sign up because you want one. Medicare has rules, and while they're not impossible, you do have to meet them.

Here's the bottom lineyou're likely to qualify if you have diabetes and either:

• Use insulin (any kindpump, pen, or even just once a day)
• Or, if you don't use insulin, have a history of serious, dangerous low blood sugar episodes ("hypoglycemia" for the medical folks)

That's it. No minimum insulin dose. No "progressive" diabetes label. Just insulin use or documented lows.

Butyou need a few other things too:

• A prescription from a doctor who accepts Medicare
• Proof that you (or a caregiver) have been trained to use the device
• A doctor's visit in the last 6 months (telehealth counts!)
• And a commitment to return every 6 months to review how it's going

These aren't suggestions. They're requirements from Medicare's official coverage policy, known as the Local Coverage Determination (LCD) L33822. Mess up one, and your coverage can get paused faster than you can say "CGM."

Hypoglycemia Rules

Now, what if you're not on insulin? Can you still get it?

Yesif you've had what Medicare calls "problematic hypoglycemia." But that's not just "I felt shaky once." Nope. They're looking for real, documented episodes that put your health at risk.

Specifically, Medicare defines this as:

1. Two or more Level 2 lowswhere your blood sugar drops below 54 mg/dLeven after your doctor changed your meds or plan at least twice
2. Or, one Level 3 eventwhere your blood sugar dropped below 54 and you became confused, passed out, or needed help from someone else (a family member, EMT, etc.)

Sounds strict? Maybe. But think of it this way: Medicare wants to make sure they're covering people who truly need itnot just want it. And honestly? If you've ever had a 3 a.m. low where someone called 911, you know how serious it is.

Here's the catch: your doctor must document this clearly in your file. "Patient had low blood sugar" isn't enough. They need to state: what the reading was, that it happened despite treatment adjustments, andif it was a Level 3who helped you.

No documentation? No coverage. It's that simple.

Coverage Details

Alright, so you qualify. What now?

Good news: Medicare covers both the Dexcom G6 and Dexcom G7 under Part B, as durable medical equipment (DME). That means they treat it like a walker or oxygen machinenecessary medical gear for people with chronic conditions.

And honestly? G7 is where it's at right now. It's smaller, easier to apply, and lasts longer. Most new patients are being set up on G7. But if you're still on a pump that plays nice with G6, some people choose to stick with it. Compatibility matters.

But here's what Medicare actually pays for:

Item	Covered?	How Often?
Dexcom G7 Sensor	Yes	Every 90 days
Transmitter	Yes	Every 6 months
Receiver	Yes	Every 5 years
Smartphone Only	No	Not covered
Follow App / Clarity	No	Free, but not part of coverage

Important note: You cannot use your phone app instead of a receiver if you're on Original Medicare. I can't tell you how many people get tripped up here. You can use your phonetotally finebut the receiver must be part of the setup. Medicare wants to see DME, not just an app.

Oh, and nothey don't cover your blood sugar strips or lancets just because you're on CGM. You'll still need those once in a while to calibrate or confirm a reading. So factor that into your monthly costs.

How to Get It

So you're eligible. You've got your prescription. Now, how do you actually get the darn thing?

You don't order it from Dexcom. You don't pick it up at the pharmacy. Nope. You go through a Medicare-approved distributora company that handles DME and bills Medicare directly.

Here's how it works:

1. Talk to your doctorget your prescription and a Certificate of Medical Necessity (CMN)
2. Call a distributorthey'll help you choose one and start the process
3. They submit the paperwork to Medicare for approval
4. Wait a few days (usually 37)
5. Get your kit shipped right to your door
6. Set it up (they can walk you through it)
7. Go back to your doctor every 6 monthsthis isn't optional

Simple, right? But it's way easier if you start with the distributor. They know the ropes. They'll check if your docs are complete, call your doctor's office if something's missing, and keep you updated.

Here are a few major distributors you can reach out to:

Distributor	Phone	Website
Byram Healthcare	1-800-775-4372	byramhealthcare.com
Edgepark	1-866-400-5183	edgepark.com
Solara Medical Supplies	1-800-423-0896 (opt 2)	solaramedical.com
CCS Medical	1-800-949-6481	ccsmed.com

Pro tip: call them and ask, "Do you handle Dexcom for Medicare Part B patients?" Saves time.

Medicare Advantage Plans

Nowwhat if you're not on Original Medicare? What if you have a Medicare Advantage plan (Part C)?

Great question. And the answer? Often, you're in an even better spot.

Many Advantage plansespecially those from UnitedHealthcare, Humana, Aetna, and Cignaoffer Dexcom through your pharmacy. That means:

• You walk into CVS or Walgreens
• Pick up your sensors
• Pay $0 copay (in many cases)

No distributor. No shipping wait. No receiver required. Some plans even let you go app-only. It's smoother, simpler, and faster.

Butand this is bigit varies by plan. Not all Advantage plans cover G7 yet. Some still only cover G6. Some want prior authorization.

So call your plan. Ask: "Do you cover Dexcom G7 for insulin users? Is it through pharmacy? Do I need a receiver?" Get it in writing.

Out-of-Pocket Costs

Let's talk money. Because even if it's "covered," you might still pay something.

Under Original Medicare (Part B):

• You pay the annual deductible first ($257 in 2025)
• After that, you pay 20% of the Medicare-approved amount

Example: If the system costs $170, you'd pay about $34 every 90 days. Not bad. But better? If you have a Medigap plan (like a G or F), it'll cover that 20%. So you pay nothing.

Medicare Advantage? It depends. Some charge $0. Some want a $10 copay. It's built into your plan's formulary. But the trend is clear: more plans offering CGMs at low or no cost.

Either waythis isn't like paying full retail ($300+/month). Medicare makes it affordable.

Avoiding Mistakes

Here's the thing: people lose coverage all the timenot because they don't qualify, but because they forget the small stuff.

The biggest killer? Missing the 6-month doctor visit.

Medicare requires it. Your distributor will remind you. Your doctor might not. But if you skip itpoof. Your next shipment gets denied. And worse? They might even ask for money back on what you already got.

Another common mistake? Switching to phone-only use. "The app's easier," you think. "Why carry a receiver?"

But if you're on Part B, the receiver is required. Use it once a day? That's not enough. If Medicare does an audit and sees you're not using it, they can revoke coverage.

So do yourself a favor: set a calendar alert for your follow-up visit now. And keep that receiver charged.

Getting the Most Out

Alrightyou've got your Dexcom. Now what?

Here's how to make it really work for you:

• Use Dexcom Clarityit's free, and your doctor can see your time-in-range, trends, and patterns
• Share your data with your care teamthey'll love it
• Keep a file of your doctor visits and any low blood sugar events
• Stick with your distributorthey're your best ally for billing and tech help

And when you go to your 6-month check-in? Bring your Clarity report. Show your progress. It helps your doctor justify continued coverageand shows Medicare you're using it the right way.

Need Help?

Still stuck? Totally normal.

Here's who to call:

• Dexcom Medicare Support: 1-888-738-3646
• 1-800-MEDICARE: For coverage questions
• Your distributor: For shipping, setup, or billing
• Your doctor: For prescriptions and records

And if you're just starting out, visit dexcom.com/medicare for training videos, forms, and step-by-step guides.

Lookdiabetes is hard. It's constant. It's exhausting. And the last thing you need is a battle with insurance.

But here's the good news: Medicare does cover Dexcom. You can get it. And with the right steps, it can be smooth, simple, and life-changing.

So take a deep breath. Call your doctor. Reach out to a distributor. And take that first step.

Because better control? Fewer fingersticks? Peace of mind at 2 a.m.? It's closer than you think.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.