OOP Costs of CGMs


(clcapece) #1

Hey, Can anyone give me some insight on the out of pocket costs of the Dexcom (G5 or G6) vs Libre CGM? I realize that it depends on insurer but any ranges you’ve experienced or heard about would be really helpful. I believe the Libre is usually more affordable–but i want to get an understanding of the difference. Thank you!


(Dennis J. Dacey, PwD) #2

Hi @clcapece, the easiest and most accurate answer to that question is to ask her insurer.
On a general basis, I’ve been told that Abbott’s Libre is less expensive than DexCom sensors but I can’t be more specific. As an aside, my out-of-pocket cost for DexCom G5 has been $0.00, and that includes all sensors, transmitters and a receiver.

Yes, a very good insurance plan for which I began paying premiums in 1963 and still pay premiums ever month now - Medicare! Yes, it has been expensive insurance but well worth what I’ve paid in.


(mikefarley) #3

Hi. I’m going to G6 when it gets Medicare approval. Currently not using a CGM, but used the older (totally inaccurate) Medtronic sensors for a while. I assumed Medicare would cover Dexcom at 80% like DME/Pump, but if you have 0 co-pay, my assumption must be wrong. Did you have any trouble getting billing squared away? Are you covered by original Medicare, or an Advantage plan? TIA


(Dennis J. Dacey, PwD) #4

Mike @mikefarley, I have Medicare Complete - a United Health PPO for which I pay the highest monthly premium permitted under law. I didn’t have any problems with billing and stuff like that; once prescription approval came through, I had a call from DexCom [or from Byram DexCem’s partner] telling me what the co-pay would probably be. I never received a bill so I went checking and found my insurance fully covered.
I expect that sometime soon that CMS [Medicare} will approve the G6 and I’ll be moved over; I’ve heard that the supply of G5 is running out - some people have had difficulty getting orders filled.


(mikefarley) #5

Thanks for the details!