Medicare covers continuous glucose monitors (CGMs) for people with diabetes who meet specific requirements

Medicare Part B covers a CGM device and its supplies if you have diabetes and use insulin. The coverage applies whether you use insulin injections or an insulin pump. You will need a prescription from your doctor, and your doctor must document that you are using insulin at least once daily.

The device itself and the sensors are covered under Part B's durable medical equipment (DME) benefit. Medicare pays 80 percent of the approved amount after you meet your Part B deductible. You pay the remaining 20 percent, unless you have a Medigap or Medicare Advantage plan that covers additional costs.

Not all CGM brands are covered at the same level. The specific model your doctor prescribes, the number of sensors Medicare will pay for per month, and the replacement schedule all depend on which device is on Medicare's approved list at the time you need it.

Key Takeaways

  • Medicare Part B covers CGMs for people with diabetes who use insulin at least once daily, with a doctor's prescription.
  • You pay 20 percent of the approved cost after meeting your Part B deductible; the exact amount depends on which CGM model your doctor prescribes.
  • Your doctor must document your insulin use and submit the prescription through a Medicare-approved DME supplier.
  • Medicare limits how many sensors you can receive per month, and this limit varies by device type.
  • If you have a Medicare Advantage plan, coverage rules may differ, so check your plan documents or call your plan directly.

Which CGM devices Medicare covers

Medicare's approved CGM list includes the FreeStyle Libre, Dexcom G6, Dexcom G7, and Medtronic Guardian. The list can change, and not every model or generation is covered. Your doctor will know which devices are currently covered and which one makes sense for your diabetes management.

When your doctor writes the prescription, they should specify the device they want you to use. The DME supplier you work with will confirm that device is covered under your specific Medicare plan before you order it. If your doctor prescribes a device that is not on the covered list, you will have to pay the full cost yourself.

How to get a CGM through Medicare

Start by talking to your doctor about whether a CGM is right for you. Your doctor will need to confirm in writing that you use insulin at least once daily. This documentation is required before any DME supplier will process your order.

Once you have the prescription, contact a Medicare-approved DME supplier. You can find these suppliers through your insurance card, by calling Medicare at 1-800-MEDICARE, or by searching the Medicare website. Give the supplier your Medicare number, your doctor's prescription, and your insurance information.

The supplier will verify your coverage, confirm your out-of-pocket costs, and ship the device and initial sensors to you. Setup and training are usually included. The entire process typically takes one to two weeks from the time you contact the supplier.

What you will pay out of pocket

Your costs depend on whether you have Original Medicare alone or a Medigap or Medicare Advantage plan. With Original Medicare, you pay 20 percent of the Medicare-approved amount for the device and each month's sensors after you meet your Part B deductible ($240 in 2024, though this amount changes yearly).

The actual dollar amount varies by device and supplier. A single sensor for a FreeStyle Libre or Dexcom device typically costs Medicare between $30 and $60 per sensor. If Medicare covers two sensors per month, your 20 percent share would be roughly $12 to $24 per month, plus any costs before you meet your deductible.

If you have a Medigap plan, check your policy to see whether it covers the 20 percent coinsurance. If you have a Medicare Advantage plan, your costs may be different — some plans cover CGMs with a copay instead of coinsurance. Call your plan to find out your exact costs before you order.

Sensor replacement and ongoing supplies

Medicare covers replacement sensors on a set schedule. Most CGM devices require a new sensor every 10 to 14 days, depending on the model. Medicare will cover the number of sensors you need for that schedule — usually two to three per month.

You will order replacement sensors through the same DME supplier you used for the initial device. Many suppliers set up automatic shipments so you receive sensors before your current one expires. If you run out of sensors between shipments, you will have to pay out of pocket for emergency replacements.

If your device breaks or stops working, contact your supplier when ready. They can usually send a replacement within a few days. Medicare covers replacement devices, but there may be limits on how often you can receive a new one — typically once every five years unless there is a medical reason for earlier replacement.

What happens if your doctor says you do not use insulin

Medicare does not cover CGMs for people who manage diabetes with oral medications alone, even if blood sugar control is difficult. If your doctor believes a CGM would help you but you do not use insulin, you have two options: start insulin therapy (which your doctor would need to prescribe and document), or pay for the CGM out of pocket.

Some people who use only oral medications choose to buy a CGM privately because the real-time glucose information helps them make better food and activity choices. The cost is usually $50 to $100 per sensor, or $100 to $300 per month depending on the device. Some manufacturers offer patient information programs that reduce this cost.

Medicare Advantage plans and CGM coverage

Medicare Advantage plans must cover at least what Original Medicare covers, but many cover more. Some Advantage plans cover CGMs for people who do not use insulin, or they may have lower copays than the 20 percent coinsurance in Original Medicare.

Your Advantage plan may also have preferred suppliers or preferred devices, meaning you will pay less if you use a specific brand. Before you ask your doctor for a prescription, call your plan and ask: which CGM devices are covered, what is my out-of-pocket cost, and which suppliers should I use. This one call can save you money and prevent delays.

Frequently Asked Questions

Can I use a CGM if I take insulin only at certain times, not every day?

Medicare requires documentation that you use insulin at least once daily. If you use insulin only occasionally or on a sliding scale, ask your doctor whether your pattern meets Medicare's definition. Your doctor can review your records and determine whether you may have access to based on how often you actually inject or infuse insulin.

What if my doctor prescribes a CGM but my Medicare Advantage plan says it is not covered?

Contact your plan when ready and ask them to review the prescription. Medicare Advantage plans must cover what Original Medicare covers, so if your doctor has documented insulin use, the plan should cover it. If the plan denies coverage, ask your doctor to file an appeal on your behalf, or contact Medicare at 1-800-MEDICARE to file a complaint.

Do I have to use the DME supplier my insurance recommends?

No. You can use any Medicare-approved DME supplier. However, some suppliers have contracts with your insurance plan that may lower your costs. Before you choose a supplier, call your insurance and ask whether they have preferred suppliers and what your costs would be with each one.

If I switch from one CGM to another, does Medicare cover both?

Medicare typically covers one CGM device at a time. If you switch devices, your doctor will need to write a new prescription, and the old device is no longer covered. Some suppliers will take back unused sensors from the old device, but this varies by supplier and device type.

What if I cannot afford the 20 percent coinsurance?

Talk to your doctor or the DME supplier about patient information programs offered by the device manufacturer. Many companies offer copay cards or reduced-cost programs for people with Medicare. You can also ask your local Area Agency on Aging whether they know of programs that help with medical equipment costs.