Medicare Part B covers continuous glucose monitors for people with diabetes who meet specific requirements

Yes, Medicare Part B covers continuous glucose monitors (CGMs) for people with diabetes who use insulin. You do not pay the full cost yourself — Medicare pays 80 percent of the approved amount after you meet your Part B deductible, and you pay 20 percent. The device must be prescribed by your doctor, and you must meet Medicare's specific medical criteria.

The coverage applies to both the monitor itself and the replacement sensors you wear on your skin. However, not every person with diabetes qualifies. Medicare limits coverage to people who inject insulin at least three times daily or use an insulin pump. If you take oral diabetes medications only, Medicare does not cover a CGM under current rules.

Key Takeaways

  • Medicare Part B covers CGMs for people who inject insulin at least three times per day or use an insulin pump, after you meet your deductible.
  • Your doctor must prescribe the CGM and document that you have type 1 or type 2 diabetes and use insulin as described.
  • You pay 20 percent of the Medicare-approved amount; Medicare pays 80 percent.
  • Replacement sensors are covered, but you may need to reorder them through a Medicare-approved supplier.
  • If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower than the standard 20 percent.

What your doctor needs to document for coverage

Your doctor must write a prescription for the CGM and include specific information in your medical record. Medicare requires documentation that you have diabetes (type 1 or type 2), that you use insulin, and that you inject insulin at least three times daily or use an insulin pump. Your doctor also needs to note that you are actively managing your diabetes and that a CGM would help you track your blood sugar.

The prescription goes to a Medicare-approved durable medical equipment (DME) supplier, not directly to the device manufacturer. Your doctor's office can tell you which suppliers they work with, or you can search for approved suppliers on Medicare.gov. The supplier will verify your coverage and handle the paperwork with Medicare before sending you the device.

How much you pay out of pocket

Your costs depend on whether you have met your Part B deductible for the year. Once you meet the deductible, Medicare pays 80 percent of the approved amount for the CGM device and the sensors, and you pay 20 percent. The approved amount varies by device and supplier, so your actual 20 percent payment depends on which CGM your doctor prescribes.

If you have a Medigap (supplemental insurance) plan, it may cover some or all of your 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 directly to ask what you will owe before you order the device.

Replacement sensors and ongoing supplies

Once Medicare approves your initial CGM, the replacement sensors are also covered under the same 80/20 split. You typically need a new sensor every 7 to 14 days, depending on the brand. Your DME supplier can set up automatic refills so you do not run out.

You may need a new prescription from your doctor each year, or your doctor may write a prescription that covers multiple refills. Ask your doctor's office how often they will need to renew the order. If your supplier runs out of stock or cannot deliver on time, ask them about backup options before you need a sensor urgently.

What happens if you do not use insulin injections or a pump

If you take diabetes pills (oral medications) only and do not use insulin, Medicare does not cover a CGM. Some people in this situation pay out of pocket for a CGM, which can cost several hundred dollars per month depending on the brand and your location. Others ask their doctor whether switching to insulin therapy would be appropriate for their health — this is a medical decision between you and your doctor, not a coverage decision.

Some private insurance plans cover CGMs for people on oral medications only, so if you have employer coverage or a retiree plan in addition to Medicare, check that plan's rules. A few states have Medicaid programs that cover CGMs more broadly, though Medicaid rules vary by state.

How to start the process

Talk to your doctor at your next visit about whether a CGM would help you manage your diabetes. Your doctor will decide whether a CGM is medically necessary for you and will write a prescription if they agree. They will also tell you which Medicare-approved DME suppliers they recommend.

Once you have the prescription, contact the DME supplier. They will ask for your Medicare number and will check your coverage before ordering the device. The supplier handles most of the paperwork with Medicare, though you may receive a notice from Medicare explaining what they approved and what you owe. Keep that notice in case you have questions about your bill later.

Frequently Asked Questions

Can I use any continuous glucose monitor, or does Medicare only cover certain brands?

Medicare covers several brands of CGMs, including Dexcom, Freestyle Libre, and Medtronic Guardian. Your doctor chooses which brand to prescribe based on what they think will work best for you. Not all suppliers stock all brands, so ask your supplier which ones they carry before your doctor writes the prescription.

What if Medicare denies my claim?

If Medicare denies coverage, the supplier or your doctor's office will send you a notice explaining why. Common reasons include not meeting the insulin requirement or missing documentation from your doctor. You can ask your doctor to resubmit with more detail, or you can file an appeal. The notice will explain how to appeal and what important date you have.

Do I need to pay anything upfront before Medicare processes my claim?

No. The DME supplier should verify your coverage with Medicare before sending you the device. You should not pay the full cost upfront and then wait for Medicare to reimburse you. If a supplier asks you to pay the full amount first, contact Medicare or your plan to confirm coverage before you pay.

Will my Medicare Advantage plan cover a CGM the same way Part B does?

Medicare Advantage plans must cover at least what Original Medicare covers, but they may have different costs or requirements. Some plans cover CGMs with a copay instead of coinsurance, or they may require prior approval from the plan before you order. Call your plan's customer service number to ask about their specific coverage before you see your doctor.

Can I switch to a different CGM brand if my current one is not working well for me?

Yes, but you will need a new prescription from your doctor. Medicare does not limit how often you can switch brands, but your doctor may recommend staying with one device long enough to see how well it works for you. Talk to your doctor about your concerns with your current device, and they can prescribe a different brand if they think it will help.