Medicare covers continuous glucose monitoring (CGM) devices for people with diabetes who meet specific criteria, but coverage depends on which type of Medicare you have and whether your doctor prescribes it as medically necessary.

If you have Original Medicare (Part B), you can get coverage for a CGM system if your doctor says it is medically necessary and you meet one of these conditions: you use insulin more than once a day, or you use an insulin pump. Your doctor must document that the CGM will help manage your diabetes. Medicare Part D (prescription drug coverage) does not cover CGM devices — Part B is what pays for them.

If you have a Medicare Advantage plan (Part C), coverage varies by plan. Some plans cover CGM at the same level as Original Medicare, while others may cover it more broadly or with different cost-sharing. You will need to check your specific plan's formulary or call the plan directly to find out what they cover.

Key Takeaways

  • Original Medicare Part B covers CGM devices for people who use insulin more than once daily or use an insulin pump, when a doctor prescribes it as medically necessary.
  • You will pay 20 percent of the approved amount after you meet your Part B deductible, and the supplier must be enrolled with Medicare.
  • Medicare Advantage plans have their own coverage rules, so you must contact your plan to learn what it covers and what you will pay out of pocket.
  • Your doctor must write an order for the CGM; Medicare will not cover it without a prescription and medical documentation.
  • The specific CGM brand and model your plan covers may be limited, so ask your doctor and supplier which devices are covered before you start.

How Original Medicare Part B Covers CGM

Under Original Medicare Part B, a CGM system is classified as durable medical equipment (DME). This means Medicare pays for the device itself, the transmitter, and the sensors you use with it. The supplier you order from must be enrolled with Medicare as a DME supplier — not all medical supply companies are, so your doctor or endocrinologist can help you find one that is.

You pay 20 percent of the Medicare-approved amount for the device and supplies after you have met your Part B deductible for the year. The exact cost depends on the approved amount Medicare sets for each component. Because CGM systems require ongoing sensor replacements (usually every 10 to 14 days), you will have regular out-of-pocket costs as long as you use the system.

Medicare covers the initial setup and training on how to use the CGM. The supplier typically handles this, though your doctor may also provide guidance. If you need help troubleshooting or replacing a faulty sensor, contact your DME supplier first — they are responsible for customer support.

What You Need to Get Coverage

Your doctor must write a written order for the CGM and include a statement that it is medically necessary for your diabetes management. Medicare requires one of these two conditions: you inject insulin at least twice per day, or you use an insulin pump. If you manage your diabetes with oral medications alone, Original Medicare will not cover a CGM, though some Medicare Advantage plans may have different rules.

You will also need to provide your Medicare number and information about your current diabetes management to the DME supplier. The supplier will submit the order and your doctor's documentation to Medicare for review. This process usually takes one to two weeks. Medicare may request additional information from your doctor if the documentation is incomplete.

Once Medicare approves the order, the supplier will contact you to arrange delivery and setup. You do not need prior authorization from Medicare before your doctor writes the order, but the supplier will handle the authorization process on your behalf.

Medicare Advantage Plans and CGM Coverage

If you are enrolled in a Medicare Advantage plan, that plan decides what it covers for CGM, not Original Medicare. Some plans follow the same rules as Original Medicare — covering CGM only for people who use insulin multiple times daily or use a pump. Other plans may cover CGM more broadly, for example for people using certain diabetes medications or with a history of low blood sugar episodes.

The best way to find out what your plan covers is to call the customer service number on your insurance card and ask specifically about CGM coverage. Ask whether your plan covers the brand your doctor recommends, what your out-of-pocket cost will be, and whether you need prior authorization. Plans change their coverage year to year, so even if you had CGM coverage last year, confirm it is still covered for this year.

Some Medicare Advantage plans require you to try other diabetes management tools first before covering CGM — for example, a basic blood glucose meter. Ask your plan whether there are any step-therapy requirements you need to complete.

Which CGM Devices Medicare Covers

Medicare covers several CGM systems, including the FreeStyle Libre, Dexcom G6, Dexcom G7, and Medtronic Guardian. However, the specific models and brands covered can change, and your individual plan may limit you to certain brands. Always confirm with your DME supplier and your insurance plan which device is covered before your doctor writes the order.

Some CGM systems are newer or more expensive than others. If your doctor recommends a brand that is not on your plan's covered list, ask whether your plan will make an exception or whether your doctor can request a coverage information. This process can take additional time, so start early if you need a specific device.

The supplier you work with may also specialize in certain brands. If you have a preference, ask your doctor whether they can refer you to a supplier who carries that brand and is enrolled with Medicare.

Out-of-Pocket Costs and Sensor Replacement

Under Original Medicare, you pay 20 percent of the approved amount for the CGM device and each sensor. The approved amount varies by device and supplier, but sensors typically cost between $30 and $60 out of pocket per sensor after your 20 percent coinsurance. Since most people replace sensors every 10 to 14 days, this can add up to $100 to $250 per month in out-of-pocket costs.

Once you reach your Part B out-of-pocket maximum for the year, Medicare covers 100 percent of approved CGM costs for the rest of that year. The Part B out-of-pocket maximum changes each year — check your Medicare summary notice or call Medicare at 1-800-MEDICARE to find out this year's limit.

If you have a Medigap supplemental insurance plan, it may help cover some of your coinsurance costs. Check your Medigap policy or call your supplemental insurance company to see what it covers for DME.

How to Start the Process

First, talk to your doctor about whether a CGM is right for your diabetes management. If your doctor agrees, ask them to write an order and submit it to a Medicare-enrolled DME supplier. Your doctor may have a preferred supplier they work with regularly.

If you do not have a supplier in mind, you can search for one on the Medicare website under "Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)" or ask your doctor for a referral. Once you contact the supplier, they will walk you through the rest of the process, including insurance verification and delivery.

If you have a Medicare Advantage plan, call your plan first to confirm coverage before your doctor writes the order. This prevents delays if your plan requires prior authorization or has specific requirements you need to meet.

Frequently Asked Questions

Can I get a CGM if I only take diabetes pills, not insulin?

Original Medicare does not cover CGM for people who manage diabetes with oral medications alone. However, some Medicare Advantage plans may cover it in certain situations. Contact your plan to ask about your specific situation. If your plan does not cover it, you may be able to purchase a CGM out of pocket.

What happens if Medicare denies my CGM order?

If Medicare denies coverage, the DME supplier will send you a notice explaining why. Common reasons include incomplete medical documentation or not meeting the insulin-use requirement. You can ask your doctor to provide additional information or request a coverage information from Medicare. Your supplier can guide you through this process.

Do I have to use the CGM brand my plan covers?

Yes, unless your doctor requests an exception. If your doctor believes a specific brand is medically necessary for you, they can submit a request for coverage of a non-covered brand. This takes longer and is not always approved, so discuss options with your doctor and plan early.

Will my CGM supplies be covered if I travel outside the United States?

Original Medicare generally does not cover medical services or supplies outside the U.S. If you travel, you may need to purchase sensors out of pocket or arrange coverage through a travel insurance plan. Check with your DME supplier about options for obtaining sensors while traveling.

How often can I get a new CGM device?

Medicare covers a new CGM transmitter and receiver every three years, assuming you continue to meet the medical necessity criteria. Sensors are covered as ongoing supplies as long as you use the system. If your device breaks or malfunctions before three years, contact your supplier about a replacement.