Dexcom 6 covered by Medicaid?


(Cathleen) #1

I am just starting to investigate this…does anyone have experience with Dexcom being covered by Medicaid? We have individual insurance and are disappointed to find that the plan didn’t cover any cgm and also certain Insulins and supplies. So, I applied for my daughter to receive Pennsylvania Medicaid due to the type 1 diagnosis and she was accepted! We are grateful for the coverage and are hoping to get her a Dexcom. It would bring so much peace of mind.


(Joel) #2

CGMs are covered by Medicare, but I don’t know about Medicaid. I’m guessing they are if you can show them the need (hypoglycemia or brittleness, need for assistance, etc)


#3

My understanding is that it can vary state by state. In my state Medicaid will currently cover the G5 but not the G6. Don’t know why. They also will not cover the Libre as it is not technically FDA approved for people under 18. The Libre is much cheaper though and can often be purchased out of pocket with a pharmacy voucher #. If you have worked with a CDE, they should be able to tell you what cgms are typically covered by Medicaid in you state and provide the vouchers for better out of pocket pricing. Good Luck!


(Cathleen) #4

Thank you, T1dadandICU-RN! That’s a good thought about showing need. Her doctor really wants her to have one and I’m sure he would document the need.


(Cathleen) #5

Thank you, Gemstone. I didn’t know about vouchers and will definitely look into that. I guess Dexcom will do a courtesy benefits check to start. I’m finding that the CDE we saw initially did not present many ideas or resources, so I think I need to look further.


#6

We had an unsatisfying first CDE experience, too. We spoke to the head of the education dept at our doctor’s office (our pedi endo is in a larger diabetes center, so lots of resources) and asked for a switch. I typically feel bad about this kind of thing but it’s an important relationship and you shouldn’t be worried about speaking up if it isn’t working. They are used to this kind of thing. It takes time to get the cgm stuff sorted through Medicaid, and far more pushing than you think it should take, but it’s worth it. Keep advocating! You can do it!


(Cathleen) #7

It is so very helpful to hear of your experience, Gemstone. I will keep advocating! It has been so much information to absorb in the course of 2 months, a whole new world. Best of luck continuing to get good resources for your child also.


(Nancy) #8

@cminer Try investigating coverage under the Durable Medical Equipment coverage of either your Medicaid/Medicare plan or private insurance. Plans don’t promote coverage for T1 under DME, and patients typically only look to the pharmacy plan to cover supplies.

Best of luck -

Nancy


(Cathleen) #9

Thank you for the tip, Nancy, I will check out “durable medical equipment.” Always good to have the right vocabulary for this new territory!


(Brittany) #10

It depends of your state I work for Medicaid with UHC and they go through dme companys like edgepark or byram I wpuld call your insurance and ask .


(Cathleen) #11

Thanks for the info, BrittanyRoy! We are anxious to get her new ID card to check benefits and get started. We have a managed Medicaid here in PA also and have purchased a secondary for her through the marketplace so she can keep her providers at Cleveland Clinic across the state line. Our current marketplace plan we had at time of diagnosis didn’t want to cover any cgm, even with a physician request!


(Brittany) #12

Having more then one insurance is hard make sure they bill thw right way Medicaid is always billed last if you have more then one insurance.


#13

My son is on Medicaid in PA. Primary insurance is through my husband’s company and that company denied G6. At diagnosis my son was given a Medicaid plan with UHC but within a month or two PA came back and decided it was cheaper to pay his portion of the company family plan (it is a good plan). Now he has the one insurance and ACCESS. They will not give him a G6 because the insurance carrier denied it. So being on Medicare has done nothing for him as far as a CGM. We’ll see what they do about a pump.


(Cathleen) #14

Thank you, Koshka. It is helpful to hear about your experience with the PA system. How frustrating that there is a barrier to getting coverage for this life saving device for a child. Good luck to you with getting the pump for your son!


(Tammy) #15

My daughter and I are both type 1 diabetics in PA on Medicaid insurance. We both have gotten a dexcom g6 in the past year and love them. It is certainly worth a try.


(Cathleen) #16

Great to hear, Tammy! I have been meaning to follow up to this post. We have just been able to receive a Dexcom for Eva. We have a primary insurance through the health insurance marketplace (which we got to allow her to continue out of state at at Cleveland Clinic) and her secondary is PA Medicaid. Between the two of them, they cover Dexcom at 100%. We are so grateful. The Dexcom has made a huge difference.
Tammy, have you been able to have PA Medicaid as an adult due to the diagnosis of T1? I am hoping that my daughter will be able to continue this coverage after age 18. Thanks so much for your input!


(Tammy) #17

Yes I still qualify for Medicaid through their MAWD Program. My daugter was 17 when diagnosed and is 19 now, so she has been switched over to MAWD also.


(Cathleen) #18

Tammy, this is wonderful to hear that PA provides for adults with T1D also! I have been concerned about my daughter as she gets closer to 18. It is upsetting to hear about people having difficulty with getting coverage for insulin and supplies. I wish there were universal coverage for all who have to live with this diagnosis!