back to Overview

How much does continuous glucose monitoring cost?

November 17, 2016 by Scott Johnson

These were hot issues in response to our last article where I asked about your experience with CGMs. Like anything we’re considering, the financial impact is a big part of the decision-making process. But because the cost depends so much on your insurance coverage, it can be confusing to find out how much you’ll end up paying.

And maybe it’s just me, but I don’t like talking to my health insurance company. It feels complicated and I’m rarely confident in the information I get. Additionally, the information changes depending on when during the benefit year I call.

What’s the importance of a benefit year?

Typically (in the U.S.), health insurance policies are done on an annual basis, and things like deductibles and out-of-pocket maximums, which act like thresholds, are reset. You’ll usually find your cost to be lower later in the benefit year after they’ve been met (even $0 in some cases).

Dexcom G5 transmitter and iPhone

For many, the benefit year is the same as a calendar year, so the end of the year might be a smart time to ask about your coverage again. You might be in for a pleasant surprise for the holidays!

More to consider?

We also have to keep in mind that each employer’s policy can be different, even with the same insurance company. So even though you and your neighbor both have health insurance from the same company, your individual coverage may be different because you work for different employers.

An opportunity?

But rather than thinking of all this complexity as a barrier and feeling intimidated by it, I believe it creates an opportunity to leverage companies like Dexcom. They have people whose full-time jobs are to dive into our insurance plans and uncover the details for us (without any cost or obligation). They know what questions to ask, they know how to interpret the answers, and they know how to explain everything back to us. Additionally, if there are any promotions or special deals happening, they’ll know that, too!

By understanding your coverage and your options, you can make smart decisions.

Dexcom G5 CGM Receiver and Jolly Ranchers

If you learn that your insurance coverage is lacking, you can advocate with your employer for better coverage. Sometimes the decision-maker in the company just doesn’t know how their policy choices affect employees living with diabetes and once informed they could make a better decision next time around.

The more we know

I hope this shed some light on the complicated landscape of insurance coverage. Like anything with diabetes, the more we know, the better we can do. And sometimes simply knowing who to ask for help makes a big difference. So take advantage of the resources out there! If you’re curious about trying a CGM, but have been afraid of what it might cost – why not let Dexcom do some homework and find out for you?

Note: There are a couple of topics I couldn’t cover here (like Medicare, expensive copays, etc.) that still keep CGMs out of reach for some. I hope to address those topics in a future article.

FacebooktwittermailFacebooktwittermail

advertisement

Stay one step ahead of diabetes.

Monitor, track and share with your Dexcom G5® Mobile Continuous Glucose Monitoring System.

  • James Coghlan

    Thanks, but I was hoping for some examples of how much it costs. Without insurance? With insurance typical PPO? With insurance HMO? Typical total copays and out of pocket costs, that sort of thing. Thank you!

  • Really great point, James, thank you. I actually started down that route but bumped into too many obstacles for a useful post. One of the biggest challenges was that each plan can have a different negotiated rate with the supplier (which is sometimes Dexcom directly, and other times a third party distributor).
    Maybe one way to get a better idea of it would be for some readers here to share their OOP (Out of Pocket) costs along with what type of plan they’re on?

  • Cherise/LADA

    Great article, I believe that the OOP and DD has increased tremendously over the past two years. People were able to met a $1,500 DD and a $3,000 OOP a lot faster two years ago, but when someone has to meet a DD of $5000 and OOP of $10,000 it is not possible especially if there are three different benefits structures. I could go on and on, but I think my blood glucose level is low.

  • Thanks, Cherise!
    I’m also hearing a lot of similar stories from friends and family about changes to their insurance plans over the past couple of years.

  • joannemary

    My son has been a JD since he was 12. He’s now 33. When he was on my husband’s company plan it was doable. When he was on a individual plan before Obamacare it was doable. What some do not understand is that all individual plans sold now are Obamacare plans and deductibles have skyrocketed from $2200. pre Obama to $6,000. to $7000. post Obama. Medications were never part of the deductible before Obamacare. A bottle of insulin use to cost @$15.00 to $60.00 now cost $200. after Obamacare and even with the cost of durable medical equipment he never meets his deductible. It has been horrendous to his diabetes. He now stretches his Omnipods (3 boxes/3month supply cost close to $800.) over 4 to 5 days and always runs his BS over 150 to 200. Why is he paying for medical services like pregnancy, etc. and none of his actual medical needs are paid for? What Obamacare forgot was that there are actual sick people out there. So while my breast exam is free, my JD son’s medical requirements are not covered. He knows of one JD friend who has actually been forced back into 1950’s JD care aka needles, 7 to 10 a day. This is a crime.

  • SAB

    A tip in case you are not aware. I get my insulin from Walmart (a friend told me) $25.00 a bottle (use 2.5 a mo). It is 70/30 no pens but it’s worth it to save what would cost me $800 a month. It’s just as good as when I used humalog. You can buy it OTC w/o prescription.

Newsletters, blog posts and tips & tricks from the monster workshop.