Medicare's CGM Coverage Expanded in 2024

Yes, Medicare's rules for continuous glucose monitors (CGMs) changed significantly in 2024. Starting January 1, 2024, Medicare Part B began covering CGMs for a broader group of people with diabetes — not just those using insulin. Previously, Medicare would only pay for a CGM if you were on insulin therapy. Now, if you have diabetes and your doctor prescribes a CGM as medically necessary, you may be covered even if you manage your condition with oral medications or diet alone.

This change affects how you get a CGM, what you pay, and which devices Medicare will cover. The shift also means more people should check their coverage status, because what was not covered before might be covered now.

Key Takeaways

  • Medicare Part B now covers CGMs for people with diabetes regardless of whether they use insulin, a major change from the insulin-only rule that existed before 2024.
  • Your doctor must prescribe the CGM as medically necessary, and you will need to use a Medicare-approved brand — currently Abbott FreeStyle Libre, Dexcom, and Medtronic Guardian.
  • You pay 20 percent of the approved amount after you meet your Part B deductible, and you can get one CGM system per month.
  • If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may differ, so contact your plan directly about your coverage.

Who Can Now Get a CGM Under Medicare

The 2024 expansion opened CGM coverage to three groups. The first group is people with diabetes who use insulin — this was already covered before 2024, but the rules stayed the same. The second group is people with diabetes who do not use insulin but whose doctor determines a CGM is medically necessary for managing their condition. The third group is people with diabetes who have had a recent episode of severe hypoglycemia (dangerously low blood sugar) or who have hypoglycemia unawareness, meaning they do not feel the warning signs of low blood sugar.

Your doctor must write an order stating that a CGM is medically necessary for your care. Medicare does not require a specific reason code, but your doctor needs to document why the device is appropriate for you. If your doctor is unsure whether to prescribe one, ask them directly whether a CGM would help you manage your blood sugar better.

Which CGM Brands Medicare Covers

Medicare covers three continuous glucose monitor systems: Abbott FreeStyle Libre, Dexcom G6 and newer models, and Medtronic Guardian. These are the only brands Medicare Part B will pay for. If you use a different brand, Medicare will not cover it, though you may be able to buy it out of pocket.

Each system works slightly differently. The FreeStyle Libre requires you to scan a sensor on your arm with a reader or phone app. Dexcom sends readings to your phone or smartwatch automatically. Medtronic Guardian integrates with insulin pumps and sends alerts to a separate receiver. Ask your doctor which system might work best for your routine, and check with each manufacturer about whether they have patient support programs that can lower your cost.

What You Pay for a CGM Under Medicare

Under Medicare Part B, you pay 20 percent of the approved amount for your CGM after you meet your annual Part B deductible (which is $240 in 2024, though this amount changes yearly). You can receive one CGM system per month. The exact dollar amount you pay depends on which brand your doctor prescribes and what Medicare's approved amount is for that brand in your region.

Your out-of-pocket cost is typically between $30 and $60 per month for the sensor and supplies, though this varies. If you have already met your deductible earlier in the year, you may pay less. If you have not met it yet, you will pay your full 20 percent until you do. Some people also may have access to for programs that help cover the remaining cost — ask the CGM manufacturer whether they offer copay information.

How to Start Getting a CGM Through Medicare

The first step is to talk with your doctor about whether a CGM would help you. Bring up your blood sugar patterns, any low blood sugar episodes, or difficulty managing your diabetes with your current method. If your doctor agrees, they will write an order for a specific CGM brand and send it to a Medicare-approved supplier.

Your doctor will choose the supplier, or you can ask them to send the order to a supplier you prefer. The supplier will verify your Medicare coverage, confirm your doctor's order, and ship the CGM system to you. This process usually takes one to two weeks. When the system arrives, the supplier or manufacturer will provide instructions on how to use it. Many suppliers also offer phone support if you have questions during setup.

Medicare Advantage and Medigap Plans

If you have a Medicare Advantage plan (Part C), your coverage for CGMs may differ from Original Medicare. Some Advantage plans cover CGMs with lower out-of-pocket costs than Original Medicare, while others may have restrictions or require prior approval from the plan. Contact your Advantage plan directly to ask about your CGM coverage before you see your doctor.

If you have a Medigap (supplemental insurance) plan, it will typically cover the 20 percent coinsurance that Original Medicare does not pay, which means you may have little or no out-of-pocket cost. Check your Medigap plan documents or call the plan to confirm. Some Medigap plans have different rules, so do not assume your coverage without checking.

What Happened Before the 2024 Change

Before January 1, 2024, Medicare Part B only covered CGMs for people who used insulin. If you had diabetes but managed it with pills or diet, Medicare would not pay for a CGM, even if your doctor thought it would help. This meant many people had to choose between paying out of pocket (often $100 to $300 per month) or going without the device.

The change reflects growing evidence that CGMs help people with all types of diabetes manage their blood sugar better, not just those on insulin. If you were denied coverage before 2024 and still have diabetes, it is worth asking your doctor again whether a CGM makes sense for you now.

Frequently Asked Questions

Do I need prior approval from Medicare before I get a CGM?

No, Medicare does not require prior approval for CGMs. Your doctor writes an order, sends it to a Medicare-approved supplier, and the supplier handles the rest. However, your Medicare Advantage plan may require prior approval, so check with your plan first if you have one.

What if my doctor prescribed a CGM before 2024 but Medicare denied it?

You can ask your doctor to submit a new order now that the rules have changed. Include a note that you are requesting coverage under the new 2024 policy. If the supplier or Medicare denies it again, ask for the reason in writing and contact your doctor to discuss next steps.

Can I switch between different CGM brands once I start using one?

Yes, you can switch brands, but your doctor needs to write a new order for the different brand. Talk with your doctor about why you want to switch — some brands may work better for your lifestyle or preferences — and they can submit the new order to a supplier.

Will Medicare cover the reader device if I use FreeStyle Libre?

Medicare covers the sensor itself. The FreeStyle Libre reader is typically included with your first order or can be purchased separately at a low cost. If you use your phone app instead of a separate reader, there is no additional device to buy.

What if I have both Medicare and Medicaid?

Medicare is your primary payer, so Medicare rules explore first. Medicaid may cover costs that Medicare does not, but rules vary by state. Contact your state Medicaid office to ask about CGM coverage under your plan.