Medicare's coverage of continuous glucose monitors depends on your diabetes type and which part of Medicare you have

Medicare Part B covers continuous glucose monitors (CGMs) for people with diabetes who meet specific requirements. The device itself, the transmitter, and the sensors are covered, but you will pay a portion of the cost through your deductible and coinsurance. Coverage is not automatic — your doctor must order it, and you must meet Medicare's medical criteria.

If you have Medicare Advantage (Part C), your coverage may differ from Original Medicare. Some Advantage plans cover CGMs more generously than Part B does; others cover them less. You need to check your specific plan's formulary or call the plan directly to learn what you pay.

Key Takeaways

  • Medicare Part B covers CGMs for people with type 1 diabetes and for people with type 2 diabetes who use insulin, but your doctor must prescribe it and you must meet other medical criteria.
  • You pay 20% coinsurance for the device and sensors after you meet your Part B deductible, which is $240 in 2024.
  • Medicare Advantage plans set their own CGM coverage rules, so you must check your individual plan to know what you will pay.
  • Your doctor's order must come from a Medicare-enrolled provider, and the CGM supplier must be Medicare-approved.

Who qualifies for Medicare CGM coverage under Part B

Medicare Part B covers CGMs for people with type 1 diabetes and for people with type 2 diabetes who use insulin. Your doctor must document that you meet one of these conditions and that a CGM is medically necessary for your care. straightforward having diabetes is not enough — the type and your treatment method matter.

You also must be using a blood glucose meter and testing strips as part of your diabetes management. Medicare requires that you have tried other glucose monitoring methods first. Your doctor will need to submit documentation showing why a CGM is the right next step for you.

If you use insulin but your diabetes type is not clearly documented in your medical record, ask your doctor to clarify it in writing before requesting the CGM. This prevents delays when Medicare reviews your claim.

What you pay for a CGM under Part B

Under Original Medicare Part B, you pay 20% coinsurance for the CGM device, transmitter, and sensors after you have met your annual Part B deductible. The deductible is $240 in 2024, though this amount changes each year. Your actual out-of-pocket cost depends on the device's Medicare-approved amount, which varies by manufacturer and model.

Most CGM supplies are considered durable medical equipment (DME) under Medicare rules. This means you rent the transmitter rather than own it outright. You purchase the sensors separately, and those costs also fall under the 20% coinsurance rule. If you have a Medigap or Medicaid plan that covers Part B coinsurance, that plan may pay some or all of your 20%.

Costs can add up quickly because you need new sensors regularly — typically every 10 to 14 days depending on the device. Over a year, your coinsurance for sensors alone can reach several hundred dollars.

How to request a CGM through Medicare Part B

Start by talking to your doctor about whether a CGM makes sense for your diabetes management. Your doctor must be enrolled with Medicare and must submit an order for the CGM. The order includes documentation of your diabetes type, your current glucose monitoring method, and why a CGM is medically necessary.

Once your doctor submits the order, you will need to choose a Medicare-approved CGM supplier. Medicare maintains a list of approved suppliers on its website. Contact the supplier your doctor recommends and give them your Medicare information. The supplier will verify your coverage and tell you what you need to pay.

The supplier handles most of the paperwork, but you may receive a notice from Medicare asking you to confirm that you ordered the device. Keep any paperwork the supplier sends you. If Medicare denies the claim, you have the right to appeal, and your doctor can help by providing additional medical documentation.

Medicare Advantage plan coverage of CGMs

If you have Medicare Advantage (Part C), your CGM coverage is set by your individual plan, not by Medicare Part B rules. Some Advantage plans cover CGMs with lower out-of-pocket costs than Original Medicare does. Others may require prior authorization or limit which CGM brands you can use.

The best way to know what your plan covers is to call the plan's customer service number on your insurance card. Tell them you want to know about CGM coverage, including whether your doctor needs to get prior authorization and what your coinsurance or copay will be. Ask them to put the answer in writing so you have it for your records.

If your Advantage plan does not cover CGMs or covers them in a way that does not work for you, you have the right to switch to Original Medicare during the annual open enrollment period (October 15 to December 7 each year). However, you cannot switch plans based solely on one benefit, so weigh the full cost of each option.

CGM brands and models Medicare covers

Medicare covers several CGM systems, including the Dexcom G6, Dexcom G7, FreeStyle Libre, and Medtronic Guardian. Coverage and costs may differ slightly by device. Your doctor can prescribe any of these, but your out-of-pocket cost will depend on which one you choose and which supplier you use.

Not all CGM features are covered the same way. For example, some devices have smartphone connectivity or cloud sharing, but Medicare covers only the core glucose monitoring function. Ask your supplier which features are included in the Medicare-covered price and which, if any, cost extra.

If you switch CGM brands, you will need a new prescription from your doctor. Medicare does not automatically cover switching between brands frequently, so discuss with your doctor whether a change is medically necessary before requesting a new device.

What to do if Medicare denies your CGM claim

If Medicare denies your CGM claim, you will receive a notice explaining the reason. Common reasons include: your diabetes type does not meet Medicare's criteria, your doctor did not submit the required documentation, or the supplier was not Medicare-approved.

You have the right to appeal. Start by contacting your supplier to ask why the claim was denied and what information Medicare said was missing. Then ask your doctor to submit additional documentation if needed. Your doctor can write a letter explaining why a CGM is medically necessary for your specific situation.

If the appeal is still denied, you can request a hearing before a Medicare administrative law judge. This process takes time, but many people win on appeal when their doctor provides strong medical justification. Your doctor's office may have experience with appeals and can guide you through the steps.

Frequently Asked Questions

Does Medicare cover CGMs for people with type 2 diabetes who do not use insulin?

No. Medicare Part B covers CGMs only for people with type 1 diabetes or people with type 2 diabetes who use insulin. If you have type 2 diabetes and manage it with oral medications or diet alone, Medicare does not cover a CGM under Part B. Your Medicare Advantage plan may have different rules, so check your plan documents.

Will my Medigap plan pay for the part of the CGM that Medicare does not cover?

It depends on your Medigap plan. Some Medigap plans cover Part B coinsurance, which would include your 20% share of the CGM cost. Check your Medigap policy documents or call your Medigap insurer to confirm. If your Medigap covers Part B coinsurance, it should pay your 20% automatically once Medicare pays its 80%.

Can I use a CGM that my doctor prescribes if the supplier is not on Medicare's approved list?

No. Medicare will not pay for a CGM from a supplier that is not Medicare-approved, even if your doctor prescribes it. Always ask your supplier whether they are Medicare-approved before placing an order. Your doctor can help you find an approved supplier in your area.

What happens to my CGM coverage if I switch from Original Medicare to a Medicare Advantage plan?

Your coverage will change based on your new Advantage plan's rules. Some Advantage plans cover CGMs more generously than Original Medicare; others cover them less or require prior authorization. Contact your new plan before your coverage starts to understand what you will pay and whether you need to switch suppliers.

Do I have to pay for the CGM upfront, or does the supplier bill Medicare directly?

The supplier typically bills Medicare directly. You pay your coinsurance amount (usually 20%) after Medicare processes the claim. However, some suppliers may ask you to pay upfront and then submit a claim for reimbursement. Ask your supplier about their billing process before you receive the device.