Which Continuous Glucose Monitors Medicare Part B Covers Right Now

What Medicare Part B covers for continuous glucose monitors

Medicare Part B covers continuous glucose monitors (CGMs) for people with diabetes who meet specific conditions. The coverage is real, but it depends on your insulin use and your doctor's prescription — not every CGM model is covered, and not every person with diabetes qualifies.

As of now, Medicare covers the FreeStyle Libre 2, the Dexcom G6, and the Medtronic Guardian 4. Coverage can change, so your best move is to check with your doctor or call Medicare directly at 1-800-MEDICARE to confirm which models are currently covered and whether you meet the requirements for your specific situation.

The main rule: you must be using insulin at least once daily to get Medicare coverage for a CGM. If you take other diabetes medications but not insulin, Medicare does not cover a CGM under Part B. Your doctor must also write an order stating that a CGM is medically necessary for your care.

Key Takeaways

Medicare Part B covers FreeStyle Libre 2, Dexcom G6, and Medtronic Guardian 4, though this list can change and varies by your specific plan.
You must use insulin at least once daily to be covered — oral medications alone do not may have access to you for Medicare CGM coverage.
Your doctor must prescribe the CGM and state it is medically necessary; you cannot order one on your own and expect Medicare to pay.
You will typically pay 20 percent of the approved amount after you meet your Part B deductible, though some Medigap or Medicare Advantage plans may cover more.
Call 1-800-MEDICARE or ask your doctor's office to verify current coverage before ordering, because covered models and rules change.

How to learn about your specific CGM is covered

The fastest way is to call your doctor's office and ask them to check with Medicare or your insurance plan. They have access to real-time coverage information and can tell you whether the model you want is covered under your plan right now. Bring the exact model name and number when you call.

You can also call Medicare directly at 1-800-MEDICARE and have your Medicare card ready. Tell them which CGM model you are interested in, and they can tell you whether it is covered and what you will pay. If you have a Medicare Advantage plan instead of Original Medicare, call the plan's customer service number on the back of your card — coverage rules differ between plans.

If you use a durable medical equipment (DME) supplier — the company that ships your diabetes supplies — they often know the current coverage rules and can tell you which models they can send to you under Medicare. Some suppliers work with only certain manufacturers, so it is worth asking.

What you pay for a covered CGM

Under Original Medicare Part B, you pay 20 percent of the Medicare-approved amount for the CGM and its supplies after you meet your Part B deductible (which is $240 in 2024, though this amount changes yearly). The actual cost you pay depends on what Medicare approves for that specific model, not what the manufacturer charges.

If you have a Medigap policy, it may cover some or all of your 20 percent share, depending on which Medigap plan you have. If you have a Medicare Advantage plan, your costs work differently — you may have a copay, coinsurance, or no cost at all, depending on your plan. Check your plan documents or call the plan to find out your exact cost.

The cost also includes the sensors and any reader devices. Some CGMs require a separate reader, while others use your smartphone. Ask your supplier whether the reader is included in the price or billed separately.

Insulin requirement and other conditions Medicare checks

Medicare requires that you use insulin at least once per day. This means basal insulin (long-acting), bolus insulin (rapid-acting), or a combination — any insulin regimen counts. If you take insulin only occasionally or use other medications instead, you do not meet this requirement.

Your doctor must also document that the CGM is medically necessary for your care. This is not a high bar — most doctors prescribe CGMs for people on insulin because they genuinely help with blood sugar control — but your doctor has to write the order. You cannot walk into a pharmacy or order online and have Medicare pay without a prescription.

Some people also need to show that they have tried other methods of blood sugar monitoring first, though this requirement has loosened in recent years. Ask your doctor whether your insurance plan requires this step before ordering.

Differences between Original Medicare and Medicare Advantage plans

Original Medicare Part B covers the three models listed above under the same rules nationwide. Medicare Advantage plans (Part C) can cover different models, charge different amounts, or have different requirements. Some Advantage plans cover additional CGM models that Original Medicare does not, while others cover fewer.

If you have a Medicare Advantage plan, call the plan's customer service number on your insurance card and ask which CGMs are covered. Do not assume that because Original Medicare covers a model, your Advantage plan does too. The plan may also require you to use a specific supplier or get prior approval before ordering.

If you are thinking about switching from Original Medicare to an Advantage plan or vice versa, CGM coverage is worth factoring into your decision, especially if you have a CGM you like and want to keep using.

How to order a covered CGM through Medicare

Start with your doctor. Tell them which CGM you want to use, and ask them to send a prescription to a Medicare-approved DME supplier. Your doctor's office may have a preferred supplier they work with, or you can choose your own.

Once you have a prescription, contact the DME supplier. They will verify your Medicare coverage, confirm that the model is covered under your plan, and tell you what you owe. They will also handle the paperwork with Medicare. You do not submit anything to Medicare yourself — the supplier does that.

The supplier will ship the CGM and initial sensors to you. You will need to pay your share (usually 20 percent after your deductible) at the time of order or when you receive the shipment, depending on the supplier's policy. After that, you order refill sensors through the same supplier, and they handle the Medicare billing each time.

What to do if your CGM model is not covered

If the CGM you want is not on Medicare's covered list, you have a few options. You can pay out of pocket for the model you prefer — CGM costs vary widely, from around $40 to $100 per month depending on the model and where you buy. Some manufacturers offer patient information programs that reduce the cost if you may have access to based on income.

You can also ask your doctor whether one of the covered models might work for you instead. The three covered models are all effective, and your doctor can help you understand the differences — some use a smartphone app, others use a separate reader, and they differ in how often you need to scan or check readings.

If you believe Medicare should cover a different model, you can file an appeal or a coverage information request, but this is a slow process and does not may provide a change. Talk to your doctor or a patient advocate at a diabetes organization if you want to explore this route.

Frequently Asked Questions

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

Your doctor's prescription is required, but you typically do not need to get written approval from Medicare first. The DME supplier handles the verification and paperwork. However, some Medicare Advantage plans do require prior approval, so check with your plan before ordering.

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

Medicare's rule is insulin at least once daily. If you take insulin every day — even just one injection — you meet the requirement. If you take insulin only occasionally or skip days, you do not meet Medicare's threshold for coverage.

What happens if I switch to a different CGM model after I start using one?

You can switch to a different covered model at any time. Tell your doctor, get a new prescription, and contact a DME supplier. There is no waiting period between models. Your costs reset based on your deductible for the calendar year.

Will my Medigap plan cover the 20 percent I owe for a CGM?

It depends on which Medigap plan you have. Most Medigap plans cover Part B coinsurance (the 20 percent), but some do not. Check your Medigap policy documents or call your Medigap insurer to confirm what they cover for DME like CGMs.

Can I order a CGM directly from the manufacturer instead of through a DME supplier?

No. Medicare requires that CGMs be ordered through a Medicare-approved DME supplier. If you order directly from the manufacturer, Medicare will not pay, and you will owe the full cost yourself.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.