What Changed in Medicare's Coverage of Continuous Glucose Monitors

Medicare now covers continuous glucose monitors for more people with diabetes

Yes, Medicare's coverage of continuous glucose monitors (CGMs) has expanded in recent years. As of January 2024, Medicare Part B covers CGMs for people with diabetes who use insulin, without requiring a separate prior authorization step for most beneficiaries. This is a significant shift from earlier rules that made CGM coverage harder to obtain and more limited in scope.

The change means that if you have Medicare and take insulin for diabetes management, you can now get a CGM covered without jumping through as many approval hoops as before. However, coverage still depends on your specific situation — what type of diabetes you have, how you manage it, and which CGM brand you choose. Understanding these details matters because your out-of-pocket costs and access to devices can vary widely.

Key Takeaways

Medicare Part B now covers CGMs for people with diabetes who use insulin, with streamlined approval for most beneficiaries as of January 2024.
You must use insulin (whether injected or via pump) to meet Medicare's coverage requirement for a CGM.
Your doctor must order the CGM and confirm you have diabetes and use insulin; Medicare does not require a separate prior authorization for most people.
You pay 20 percent coinsurance after your Part B deductible, and the actual cost depends on which CGM brand your doctor prescribes.
Some CGM brands are covered under Part B (the monitor itself), while supplies and replacements may fall under different coverage rules.

Who qualifies for Medicare CGM coverage now

To have a CGM covered by Medicare Part B, you must have diabetes and use insulin daily. This includes people who inject insulin multiple times a day, use an insulin pump, or use a combination of insulin and other diabetes medications. If you manage your diabetes with pills alone (oral medications), Medicare does not currently cover a CGM for you.

Your doctor must write an order for the CGM and document that you have diabetes and use insulin. Medicare removed the requirement for a separate prior authorization form for most beneficiaries starting in January 2024, which means your doctor's order and your medical record are usually enough. However, some situations — such as switching between CGM brands or having a recent claim denial — may still trigger a review.

What the coverage actually pays for

Medicare Part B covers the CGM receiver or reader device itself. Depending on which brand your doctor prescribes, this might be a standalone device, a smartwatch, or a smartphone app. The covered amount is based on Medicare's allowable charge for that specific device, which varies by manufacturer.

You pay 20 percent of the Medicare-approved amount after you meet your Part B deductible (which is $240 in 2024, though this changes yearly). If the device costs more than Medicare's allowable charge, you may owe the difference as well, depending on whether your supplier is a Medicare-participating provider. Replacement devices are covered under the same rules if your original device is lost, stolen, or no longer working.

Sensor strips and other supplies — the parts you replace regularly — are covered under Part B durable medical equipment rules. You typically pay 20 percent coinsurance for these as well, but the frequency of replacement coverage is set by Medicare policy and may not match how often you actually need new sensors.

Which CGM brands Medicare covers

Medicare covers several CGM brands, including Dexcom, Freestyle Libre, Medtronic Guardian, and Eversense. However, coverage and out-of-pocket costs can differ between brands because Medicare's allowable charge is set separately for each one. Your doctor's choice of brand, your insurance plan (if you have a Medigap or Medicare Advantage plan), and your supplier's participation status all affect what you actually pay.

Before your doctor orders a specific CGM, ask which brands are covered under your Medicare plan and what your coinsurance will be. Some Medicare Advantage plans add their own coverage rules on top of Medicare Part B, so your costs may be lower or higher than standard Medicare. If your doctor recommends a brand that is not covered, ask whether an alternative brand would work for your diabetes management.

How to get a CGM through Medicare

Start by talking to your doctor about whether a CGM would help your diabetes management. Your doctor will need to confirm that you use insulin and that a CGM is medically necessary for you. Once your doctor agrees, they will write an order for a specific CGM brand and send it to a Medicare-approved supplier.

The supplier will contact you to verify your Medicare information, confirm your address, and arrange delivery. You do not need to submit a separate prior authorization request for most situations — your doctor's order and your medical record are usually sufficient. If Medicare or the supplier needs more information, they will contact you or your doctor directly.

After you receive the device, you will get a bill from the supplier for your coinsurance (20 percent of the Medicare-approved amount). Keep your receipts and explanation of benefits statements so you can track what you have paid toward your Part B deductible and out-of-pocket maximum.

What changed from the old coverage rules

Before January 2024, Medicare required a prior authorization form — a formal request from your doctor to Medicare — before covering a CGM. This process added weeks to the approval timeline and sometimes resulted in denials that required appeals. The new streamlined process removes this step for most beneficiaries, meaning you can get a CGM faster once your doctor orders it.

Medicare also expanded coverage to include more CGM brands and clarified that people using insulin pumps (not just multiple daily injections) are covered. The allowable charges for some devices have been adjusted to better reflect current market prices, though this varies by brand and changes periodically.

One thing that has not changed: Medicare still requires that you use insulin. If you manage your diabetes with oral medications only, you are not covered for a CGM under these rules, even if your doctor thinks one would help you.

Questions to ask your doctor

Before your doctor orders a CGM, ask these specific questions: Which CGM brands do you recommend for my type of diabetes? Is this brand covered by my Medicare plan? What will my out-of-pocket cost be? How often will I need to replace the sensor, and is that covered? What happens if the device stops working or I lose it? Can you send the order directly to a Medicare-approved supplier, or do I need to find one myself?

Also ask whether your doctor's office handles the supplier coordination or whether you will need to contact the supplier directly. Some offices have preferred suppliers they work with regularly, which can speed up the process. If your doctor is unsure about current Medicare coverage, ask them to check with their billing staff or contact Medicare directly at 1-800-MEDICARE.

When to contact Medicare or your supplier

Contact Medicare at 1-800-MEDICARE if your doctor's order was submitted but you have not heard from a supplier within two weeks. Also call if you receive a bill you do not understand or if Medicare denies coverage and you want to appeal. Medicare can tell you the exact allowable charge for your device and confirm whether prior authorization is needed in your specific situation.

Contact your supplier if you have received the device but it is not working properly, if you need replacement sensors and are unsure whether they are covered, or if you have questions about your bill. Keep the supplier's contact information and your order number handy so you can reference them in any conversation.

Frequently Asked Questions

Do I need prior authorization from Medicare to get a CGM now?

Most people do not. As of January 2024, Medicare removed the prior authorization requirement for CGMs. Your doctor's order and confirmation that you use insulin are usually enough. However, if you have had a recent denial or are switching between brands, Medicare may request additional information.

What if I use insulin but my Medicare Advantage plan has different coverage rules?

Medicare Advantage plans must cover at least what Original Medicare covers, but they can add their own rules. Contact your plan directly to ask about CGM coverage, coinsurance amounts, and which brands are preferred. Your plan's formulary or coverage document will list these details, or you can call the member services number on your insurance card.

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

Medicare Part B does not cover CGMs for people who manage diabetes with oral medications alone. If your doctor thinks a CGM would help, you would need to pay out of pocket or explore whether a manufacturer offers a patient information program. Talk to your doctor about whether switching to insulin therapy is an option for your diabetes management.

How much will I pay out of pocket for a CGM?

You pay 20 percent coinsurance after your Part B deductible. The exact amount depends on Medicare's allowable charge for your specific CGM brand, which varies. Ask your supplier for an estimate before you receive the device so you know what to expect. Your costs count toward your Part B out-of-pocket maximum.

What if my CGM stops working or I lose it?

Replacement devices are covered under Medicare Part B if your original device is lost, stolen, or no longer working. You will need a new order from your doctor and will pay coinsurance again. Contact your supplier to report the problem and ask about the replacement process — some suppliers can expedite replacement devices.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.