Medicare's Coverage of Continuous Glucose Monitors

Medicare Part B covers continuous glucose monitors (CGMs) for people with diabetes who meet specific requirements. The coverage includes the monitor itself, the sensors, and the transmitter — but only if your doctor prescribes it and you have the right type of diabetes diagnosis. You will pay 20% of the approved amount after you meet your Part B deductible, the same as other durable medical equipment.

The device must be obtained through a Medicare-approved supplier, and your doctor must document that you need it. Not every person with diabetes qualifies; Medicare has clear rules about who can receive one at no upfront cost beyond your regular Part B cost-sharing.

Key Takeaways

  • Medicare Part B covers CGMs for people with Type 1 diabetes or Type 2 diabetes on insulin, if a doctor prescribes it as medically necessary.
  • You pay 20% coinsurance after your Part B deductible is met; the device itself has no separate copay.
  • Your doctor must submit a prescription and medical documentation to a Medicare-approved DME supplier before you can receive a CGM.
  • Coverage includes the monitor, sensors, and transmitter, but you must replace sensors regularly at the schedule your device requires.
  • If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower than the standard 20% coinsurance.

Who Qualifies for Medicare CGM Coverage

Medicare covers CGMs for people with Type 1 diabetes or Type 2 diabetes who use insulin. Your doctor must document that the CGM is medically necessary for your care — meaning it will help manage your blood sugar and prevent serious complications. If you take insulin injections or use an insulin pump, you are more likely to meet this standard than if you manage diabetes with oral medications alone.

Medicare does not cover CGMs for people with Type 2 diabetes who do not use insulin, even if your doctor thinks one would help. This is a hard boundary in the coverage rules. If you fall into this category, you may want to ask your doctor whether your insurance plan (if you have a Medigap or Medicare Advantage plan) covers it separately, or whether switching to insulin therapy would make a CGM available to you.

How to Get a CGM Through Medicare

Start by talking to your doctor about whether a CGM makes sense for your diabetes management. Your doctor will need to write a prescription that includes your diagnosis, the type of CGM you need, and a statement that it is medically necessary. Do not buy a CGM on your own and then try to get Medicare to reimburse you — Medicare will not pay for devices you purchase without prior authorization.

Once your doctor has written the prescription, you will need to contact a Medicare-approved durable medical equipment (DME) supplier. Your doctor's office can often tell you which suppliers are in your area, or you can search the Medicare supplier directory at dmepos.cms.gov. The supplier will verify your Medicare coverage, collect your prescription, and handle the paperwork with Medicare. They will also fit you with the device and show you how to use it.

The whole process usually takes one to two weeks from the time you contact the supplier. During that time, the supplier is checking with Medicare to confirm coverage and getting approval. You should not have to pay anything upfront if the supplier is in-network and your coverage is confirmed.

What You Pay Out of Pocket

Under Medicare Part B, you pay 20% of the approved amount for the CGM device after you have met your annual Part B deductible. The approved amount is set by Medicare, not by the supplier's list price. In 2024, the Part B deductible is $240, but this amount changes yearly.

Your actual cost depends on the specific CGM model and the approved amount Medicare assigns to it. For example, if Medicare approves $3,000 for a particular CGM system and you have already met your deductible, you would pay $600 (20% of $3,000). Sensors that you replace every 10 to 14 days are also covered under the same 20% coinsurance rule.

If you have a Medigap plan, it may cover some or all of your 20% coinsurance, which would lower your out-of-pocket cost significantly. If you have a Medicare Advantage plan, your costs depend on your plan's specific coverage — some plans cover CGMs with a copay instead of coinsurance, and some may cover them at no cost if you use an in-network supplier.

CGM Models That Medicare Covers

Medicare covers several CGM systems, including the Dexcom G6, Dexcom G7, FreeStyle Libre, Medtronic Guardian, and others. The list of covered devices can change, and not all models are covered in all situations. Your doctor will know which models are covered for your type of diabetes and prescription needs.

Some CGMs work with insulin pumps, and some work with your smartphone or a separate reader. Medicare covers the monitor and transmitter, but if you want to use it with a pump that is not covered by Medicare, you may have additional out-of-pocket costs for the pump itself. Ask your doctor and your DME supplier which combination of devices will work best for you and what your total costs will be.

Replacing Sensors and Ongoing Use

CGM sensors need to be replaced every 10 to 14 days depending on the model. Medicare covers the cost of replacement sensors under the same 20% coinsurance as the initial device. You will order replacement sensors through your DME supplier, and they will be shipped to you on a schedule that matches when you need them.

Keep track of when your sensors expire and order new ones before you run out. If you miss a sensor replacement and have a gap in monitoring, Medicare will not cover a replacement sensor for that gap — you would have to pay out of pocket. Some people set phone reminders or ask their pharmacy to help them track the schedule.

What to Ask Your Doctor

Before you pursue a CGM, ask your doctor these questions:

  • Do I meet Medicare's requirements for CGM coverage based on my diabetes type and insulin use?
  • Which CGM model do you recommend for my situation, and is it covered by Medicare?
  • Will you write a prescription for a CGM, and do you have a preferred DME supplier I should contact?
  • What is the estimated out-of-pocket cost for me, based on my deductible status and insurance plan?
  • How often will I need to replace sensors, and how do I order them?

Frequently Asked Questions

Does Medicare cover CGMs for Type 2 diabetes without insulin?

No. Medicare covers CGMs only for people with Type 1 diabetes or Type 2 diabetes who use insulin. If you have Type 2 diabetes and do not use insulin, Medicare will not cover a CGM, even if your doctor prescribes one. Check with your Medicare Advantage or Medigap plan to see if they cover it separately.

What happens if I buy a CGM without going through Medicare first?

Medicare will not reimburse you for a device you buy on your own. You must have a prescription from your doctor and order through a Medicare-approved DME supplier before Medicare will pay its share. If you have already purchased one, contact your supplier to see if they can retroactively process it through Medicare.

Do I have to use a specific brand of CGM?

No. Medicare covers several brands, including Dexcom and FreeStyle Libre. Your doctor will recommend a model based on your needs, but you can ask about other covered options. Your DME supplier can tell you which brands they stock and what your costs would be for each one.

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

No. Medicare Advantage plans set their own coverage rules for CGMs. Some cover them with a copay, some with coinsurance, and some may cover them at no cost. Call your plan's customer service number to ask about CGM coverage before you see your doctor.

What if Medicare denies my CGM claim?

If Medicare denies coverage, your DME supplier should tell you why. Common reasons include missing documentation from your doctor, a diagnosis that does not meet Medicare's rules, or ordering from a non-approved supplier. Ask your doctor to resubmit the prescription with more detail about medical necessity, or contact Medicare directly to understand the denial.