Medicare expanded continuous glucose monitor coverage in 2024, but the rules depend on your plan type and diabetes treatment

Starting January 1, 2024, Medicare Part B made it easier for people with type 2 diabetes to get a continuous glucose monitor (CGM) without requiring insulin injections first. Previously, Medicare covered CGMs only for people using insulin. Now, people managing type 2 diabetes with non-insulin medications — including GLP-1 drugs like semaglutide — may also may have access to. The change applies to Original Medicare (Part B), though coverage details and costs vary by plan.

If you have type 1 diabetes or use insulin for type 2 diabetes, your coverage did not change — you already had access. The 2024 shift opened the door for a larger group of people whose blood sugar patterns benefit from real-time glucose readings but who do not inject insulin.

Key Takeaways

  • Medicare Part B now covers CGMs for some people with type 2 diabetes who do not use insulin, if they meet specific criteria set by their doctor.
  • You will pay 20 percent coinsurance for the CGM device and supplies after you meet your Part B deductible, unless you have a Medigap or Medicare Advantage plan that covers more.
  • Your doctor must document that a CGM is medically necessary for your specific diabetes management — the device is not automatic even if you meet the basic criteria.
  • Medicare Advantage plans may have different rules, copays, or prior authorization requirements, so you need to check your individual plan documents.
  • The specific CGM brands and models covered can vary; ask your doctor which devices Medicare will pay for before you choose one.

Who qualifies for CGM coverage under the 2024 rules

To may have access to for a CGM under Medicare Part B in 2024, you must have type 2 diabetes and meet at least one of these conditions: you inject insulin, you take a GLP-1 receptor agonist (such as semaglutide, dulaglutide, or tirzepatide), or you take a sulfonylurea or meglitinide medication. Your doctor must also determine that a CGM is medically necessary for your individual case — straightforward having diabetes and taking one of these medications does not automatically mean Medicare will cover it.

If you have type 1 diabetes, you have been able to get a CGM through Medicare Part B for several years. The 2024 change does not affect your coverage, but it does mean more people in the type 2 category now have the same option.

People on Medicare Advantage plans should check their plan documents or call their plan directly, because Advantage plans can set their own coverage rules within Medicare guidelines. Some plans may cover CGMs more broadly, while others may have stricter limits or require prior authorization from the plan before you order a device.

How much you pay for a CGM on Medicare Part B

Under Original Medicare Part B, you pay 20 percent coinsurance for the CGM device and the sensor supplies after you have met your annual Part B deductible. The deductible for 2024 is $240. The actual amount you owe depends on what Medicare allows for the specific device your doctor prescribes — this varies by manufacturer and model.

For example, if Medicare's allowed amount for a month's supply of sensors is $300, you would pay $60 out of pocket (20 percent) after your deductible is met. Replacement sensors typically come monthly, so your ongoing cost is the 20 percent coinsurance each month for as long as you use the device.

If you have a Medigap (supplemental insurance) plan, it may cover some or all of your coinsurance, depending on which Medigap plan you own. If you have a Medicare Advantage plan, your out-of-pocket costs depend entirely on that plan's structure — you might pay a copay instead of coinsurance, or the plan might cover the device differently. Contact your Advantage plan before ordering to understand your actual cost.

How to request a CGM through Medicare

Start by talking to your doctor. Your doctor needs to document that a CGM is medically necessary for your diabetes management and write an order for the specific device. Medicare requires this medical necessity information — you cannot order a CGM on your own and ask Medicare to pay.

Once your doctor has written the order, you will work with a durable medical equipment (DME) supplier that is enrolled with Medicare. Your doctor's office may have a preferred supplier, or you can search for one using the Medicare Supplier Directory at dmepos.cms.gov. The DME supplier handles the paperwork with Medicare, including any prior authorization if your plan requires it.

The DME supplier will verify your coverage, confirm you have met your deductible, and tell you what your out-of-pocket cost will be. They will then ship the CGM device and initial sensors to you. You will need to set up the device and may receive training from the supplier or the device manufacturer on how to use it.

Differences between Original Medicare and Medicare Advantage plans

Original Medicare Part B covers CGMs under the rules described above — 20 percent coinsurance after your deductible. However, Medicare Advantage plans (Part C) operate under different rules. Each Advantage plan decides whether to cover CGMs, how much you pay, and whether prior authorization is required.

Some Advantage plans cover CGMs with a copay (for example, $50 per month) instead of coinsurance. Others may cover the device only for people using insulin, ignoring the 2024 expansion. A few plans may not cover CGMs at all. You must check your specific plan's formulary and coverage documents, or call the plan's customer service line, to know what applies to you.

If you are thinking about switching plans during the annual enrollment period (October 15 to December 7), CGM coverage is one factor worth comparing. A plan with lower CGM costs might save you money over the year, especially if you use the device long-term.

Which CGM devices Medicare covers

Medicare covers several continuous glucose monitor systems, but the list can change and varies slightly by region. The most commonly covered devices include the FreeStyle Libre (Abbott), Dexcom G6 and newer Dexcom models, and the Medtronic Guardian system. However, not every model or version is covered, and coverage can depend on your specific situation.

Before you or your doctor choose a device, confirm with your DME supplier or Medicare that the specific model is covered under your plan. Choosing an uncovered device means you pay the full cost out of pocket. Your doctor can help you understand which covered options work best for your diabetes management style.

What to do if Medicare denies your CGM request

If Medicare or your Advantage plan denies your CGM request, you have the right to appeal. The appeal process differs depending on whether you have Original Medicare or an Advantage plan.

For Original Medicare, you can file a redetermination request within 120 days of the denial notice. You or your doctor can submit additional medical information explaining why a CGM is necessary for your care. Many denials are overturned on appeal when doctors provide detailed documentation of blood sugar patterns or other clinical reasons the device is needed.

For Medicare Advantage plans, the appeal process is faster but follows the plan's own rules. Contact your plan's appeals department and ask for an expedited review if your doctor says the device is urgent. Advantage plans must respond to appeals within specific timeframes set by Medicare.

Frequently Asked Questions

Do I need to use insulin to get a CGM covered by Medicare in 2024?

No, not anymore. If you have type 2 diabetes and take a GLP-1 drug, a sulfonylurea, or a meglitinide, you may may have access to even without insulin. Your doctor still needs to determine that a CGM is medically necessary for your individual case. People using insulin continue to may have access to as before.

Will my Medicare Advantage plan follow the same 2024 rules as Original Medicare?

Not necessarily. Advantage plans can set their own coverage rules. Some may follow the new guidelines, while others may have stricter or looser requirements. Check your plan documents or call your plan to find out what it covers.

What happens if I switch from one CGM brand to another?

You can switch, but your doctor needs to write a new order for the different device, and you will need to verify that the new device is covered by your Medicare plan. Some people switch because they prefer one system's features or accuracy, or because their plan covers one brand better than another.

If I have both Original Medicare and a Medigap plan, how much will I pay for a CGM?

You pay 20 percent coinsurance to Original Medicare after your deductible. Your Medigap plan then covers some or all of that coinsurance, depending on which Medigap plan you have. Plans C, D, G, and M typically cover coinsurance; Plans A, B, and L do not. Check your Medigap plan documents to see what it covers.

Can I get a CGM if I manage my type 2 diabetes with diet and exercise alone?

Medicare does not cover CGMs for people who do not take diabetes medications. If you manage your diabetes without medication, you would need to pay for a CGM out of pocket. Some people in this situation choose to purchase one privately if they want the real-time glucose data.