Medicare's Continuous Glucose Monitor Coverage in 2024

Medicare expanded coverage for continuous glucose monitors (CGMs) in 2024, but the change applies only to people with type 1 diabetes who use insulin. If you have type 2 diabetes or do not use insulin, Medicare does not cover CGMs under the current rules, regardless of how you manage your blood sugar. The expansion removed a previous requirement that you test your blood sugar at least four times daily before Medicare would pay for a CGM — that barrier no longer exists for type 1 insulin users.

The coverage change took effect January 1, 2024. Medicare Part B now covers the sensor, transmitter, and receiver for CGM systems, along with the supplies you need to insert and maintain them. You pay 20 percent of the approved amount after you meet your Part B deductible; Medicare covers the remaining 80 percent. The specific CGM brands and models covered depend on your plan, so you will need to check with your insurer or the manufacturer to confirm your device is on the covered list.

Key Takeaways

  • Medicare Part B covers CGMs for people with type 1 diabetes who use insulin, effective January 1, 2024, without requiring proof of frequent blood sugar testing.
  • You pay 20 percent of the approved amount after your Part B deductible; Medicare covers 80 percent of the cost.
  • Type 2 diabetes and non-insulin users are not covered under current Medicare rules, even if a doctor prescribes a CGM.
  • Your specific CGM model must be on your plan's covered device list, so contact your insurer or the device maker before ordering.
  • You need a prescription from your doctor and must work through a Medicare-approved supplier to receive the device and supplies.

Who Qualifies for Medicare CGM Coverage

You must have type 1 diabetes and use insulin to may have access to. Medicare does not cover CGMs for type 2 diabetes, even if you take insulin injections or use an insulin pump. This is the single largest restriction on the 2024 coverage change — many people with type 2 diabetes who could benefit from a CGM remain uncovered by Medicare.

You do not need to prove you test your blood sugar a certain number of times per day. Before 2024, Medicare required evidence of at least four daily finger-stick tests; that requirement was removed. If you have type 1 diabetes and use insulin, you now meet the basic criteria. Your doctor still needs to prescribe the CGM and document that it is medically necessary for your care, but the prescription itself is the main hurdle, not proof of testing habits.

How to Get a CGM Through Medicare

Start by talking to your doctor. Tell them you want to use a continuous glucose monitor and ask them to write a prescription. The prescription should specify the CGM model or brand you want — different manufacturers make different devices, and not all are covered equally by all Medicare plans. Your doctor may have a preference based on your diabetes management, or they may ask which device you prefer.

Next, contact a Medicare-approved supplier. These are companies that Medicare has vetted to sell medical equipment and supplies. You can find approved suppliers by calling Medicare at 1-800-MEDICARE or by searching the Medicare supplier directory online. Tell the supplier which CGM model your doctor prescribed and confirm it is covered under your plan. The supplier will handle the paperwork, send the device to you, and bill Medicare directly. You will receive an explanation of benefits showing your cost-share (usually 20 percent after your deductible).

Keep your prescription and any paperwork the supplier sends you. If Medicare denies the claim or your plan says the device is not covered, you will need these documents to appeal. Appeals can take several weeks, so do not throw anything away when ready after you receive your device.

What CGM Devices Medicare Covers

Medicare covers several continuous glucose monitor systems, but the exact list varies slightly by plan and can change during the year. The most widely covered brands include FreeStyle Libre, Dexcom, and Medtronic Guardian. However, not every model from each brand is covered — for example, some older versions or newer models may have different coverage status.

Your Medicare Advantage plan (Part C) may have a different covered device list than Original Medicare (Part A and Part B). If you are in a Medicare Advantage plan, call your plan directly to ask which CGMs are covered. If you have Original Medicare, ask your supplier or call 1-800-MEDICARE. Do not assume a device is covered just because it is available at a pharmacy or online — Medicare coverage and commercial insurance coverage are separate, and what your neighbor's private insurance covers may not explore to you.

Some suppliers may try to sell you a device that is not on your plan's covered list and ask you to pay out of pocket. Before you agree to any payment, confirm with your plan in writing that the device is not covered. If it is not covered, you have the right to decline and ask the supplier to order a covered alternative instead.

Your Out-of-Pocket Costs

Under Original Medicare Part B, you pay 20 percent of the Medicare-approved amount for the CGM system and supplies after you meet your annual Part B deductible. The deductible for 2024 is $240. Once you reach $240 in Part B costs, Medicare covers 80 percent and you pay 20 percent for the rest of the year.

The actual dollar amount you pay depends on what Medicare approves for your specific device. Medicare sets an approved amount for each CGM model, and that amount varies. For example, the approved amount for a month's worth of sensors and transmitter may range from $150 to $300, but the exact figure depends on the device and your region. Your supplier should tell you the approved amount and your expected cost-share before you order.

If you have a Medicare Advantage plan, your out-of-pocket costs may be different. Some Advantage plans cover CGMs with a copay instead of coinsurance, or they may have different deductibles. Check your plan documents or call your plan's customer service to learn your exact costs before you order.

What Did Not Change: Type 2 Diabetes and Non-Insulin Users

The 2024 expansion did not extend to people with type 2 diabetes. Medicare still does not cover CGMs for type 2, regardless of whether you use insulin, take oral medications, or manage your diabetes through diet and exercise. This is a significant gap, because many people with type 2 diabetes could benefit from seeing real-time glucose trends, especially those who use insulin.

If you have type 2 diabetes and want a CGM, you have a few options. Some commercial insurance plans cover CGMs for type 2 diabetes — check your plan documents or call your insurer. You can also pay out of pocket; CGM systems typically cost $200 to $400 per month depending on the brand and how many sensors you need. Some manufacturers offer patient information programs or discounts for uninsured or underinsured people, so contact the maker directly to ask.

Advocacy groups and medical organizations have pushed Medicare to expand CGM coverage to type 2 diabetes, but as of 2024 that change has not happened. If you want to voice support for broader coverage, you can contact your elected representatives or join patient advocacy organizations focused on diabetes.

Common Mistakes to Avoid

Do not order a CGM directly from a pharmacy or online retailer without confirming Medicare coverage first. Some retailers will sell you a device and tell you to submit the receipt to Medicare for reimbursement — this rarely works, because Medicare requires the device to come from an approved supplier. You may end up paying full price out of pocket.

Do not assume your Medicare Advantage plan covers the same devices as Original Medicare. Call your specific plan and ask which CGMs are on their covered list. A device that is covered under Original Medicare may not be covered under your Advantage plan, or it may require a higher copay.

Do not wait to get a prescription if your doctor has already suggested a CGM. The prescription itself does not cost you anything, and having it in hand makes the ordering process faster. If you delay and then change your mind later, you will have to ask your doctor for the prescription again.

Do not ignore an explanation of benefits that shows a higher cost-share than you expected. If Medicare denies the claim or says the device is not covered, you have the right to appeal. Contact your supplier or Medicare to understand why the claim was denied before you pay anything.

Frequently Asked Questions

Does Medicare cover CGM supplies like sensors and transmitters separately?

Yes. Medicare covers the sensors, transmitters, receivers, and insertion supplies as part of the CGM benefit. You do not pay separately for each component — they are all bundled into the approved amount. However, you still pay your 20 percent coinsurance on the total approved amount.

What if my doctor says I need a CGM but I have type 2 diabetes?

Medicare will not cover it under current rules. Ask your doctor whether your commercial insurance (if you have it) covers CGMs for type 2 diabetes, or explore patient information programs from the CGM manufacturer. Some programs offer discounted or free devices based on income.

Can I switch CGM brands if I am already using one that Medicare covers?

Yes, but you will need a new prescription from your doctor specifying the new brand. Contact a Medicare-approved supplier and confirm the new device is covered under your plan. There may be a waiting period between switching devices, depending on your plan's rules.

Do I need to use a specific supplier, or can I order from any pharmacy?

You must use a Medicare-approved supplier for Medicare to cover the cost. Not all pharmacies are approved Medicare suppliers for CGMs. Call 1-800-MEDICARE or search the Medicare supplier directory to find an approved supplier near you or that ships to your state.

What happens if Medicare denies my CGM claim?

You have the right to appeal. Contact your supplier or Medicare to ask why the claim was denied — common reasons include the device not being on your plan's covered list, missing documentation from your doctor, or a coding error. Your supplier can often resubmit the claim with corrected information.