Therapeutic CGM Coverage at a Glance
| Medicare Plan | Therapeutic CGM Coverage |
|---|---|
| Part A (Inpatient) | N/A |
| Part B (Outpatient) | Covers 80% of therapeutic continuous glucose monitor and associated supply costs once you meet your Part B deductible. |
| Part C (Medicare Advantage) | Coverage mirrors Part B. Select plans may offer additional benefits. |
| Part D (Prescription Drugs) | N/A |
| Supplemental Insurance | Can help cover out-of-pocket costs related to CGMs. Coverage varies by plan. |
Medicare Coverage for Therapeutic CGM
Medicare Part B covers therapeutic continuous glucose monitors (CGM) such as the FreeStyle Libre 2 and the Dexcom G6 for people with diabetes.
Medicare covers therapeutic continuous glucose monitors as durable medical equipment (DME). You will be responsible for your Medicare Part B deductible and 20% of the Medicare-approved cost. Medicare will cover the other 80% after you meet your deductible.
Before You Decide
Make sure your CGM supplier is enrolled in Medicare and accepts the Medicare-approved price for the device and its supplies. If not, the supplier may charge you any price and Medicare will not pay.
A Medigap policy — also called Medicare Supplement insurance — can cover some of your out-of-pocket costs for the Medicare Part B deductible and coinsurance. Additionally, Medicare Advantage plans are required to cover everything included in Medicare Part A and B coverage but may offer additional benefits.
Both Medigap and Medicare Advantage plans are sold by private insurers. Your plan’s administrator can verify your policy’s coverage of therapeutic CGM.
Medicare Eligibility for a Therapeutic CGM
A therapeutic CGM is a medical device approved by the U.S. Food and Drug Administration as a replacement for home blood sugar monitors. It provides you and your doctor with the medically necessary information to make diabetes treatment decisions, such as changes in diet and your insulin dosage.
To qualify for a therapeutic CGM, you must be undergoing treatment for diabetes and meet certain other criteria.
To be eligible for a therapeutic CGM under Medicare, you must meet the following requirements.
- You are using insulin to treat Type 1 or Type 2 diabetes.
- You need to check your blood sugar four or more times per day.
- You must use an insulin pump or receive three or more insulin injections per day.
- You must make routine, in-person visits to your doctor.
- Your doctor has determined that you meet all Medicare eligibility requirements.
The decision between a therapeutic CGM or a traditional monitor is one you should make after talking to your doctor. A therapeutic CGM may be a better option if you use insulin and frequently change your dosage.
Medicare Coverage of Therapeutic CGM Supplies
Medicare Part B medical insurance covers maintenance supplies for durable medical equipment — such as a therapeutic CGM — that ensure the equipment works properly.
Medicare-covered therapeutic CGM supplies include:
- Test strips
- Lancets
- Lancing devices
- Glucose control solutions
- Other related supplies necessary for the proper operation of the therapeutic CGM
Medicare Part B may limit how often or how many supplies you can buy at one time. For example, insulin users are able to get up to 100 test strips and lancets per month. Patients who don’t use insulin are limited to roughly a third of that amount.
Medicare does not cover some diabetes supplies, such as syringes, needles and alcohol swabs.
FAQs About Medicare's Coverage of Therapeutic Continuous Glucose Monitors
How much does it cost (out of pocket) to buy FreeStyle Libre or Dexcom CGM sensors per month?
Prices depend on the model and the supplier. If you shop around, you may be able to find FreeStyle Libre sensors for as low as $75 per month while Dexcom G6 sensors can cost about four times that price per month. These items are considered medical supplies under Medicare coverage rules, so you are responsible for your Medicare Part B deductible — $240 in 2024 — and then 20% of the cost after you’ve hit the deductible.
Can a doctor do a virtual appointment and prescribe a CGM?
Medicare and private insurance allow a doctor to diagnose and prescribe treatment options such as a continuous glucose monitor through telehealth. This is part of expanded telehealth coverage under Medicare that started during the pandemic.
How do continuous glucose monitors feel? What is the process for having them placed?
How your CGM will feel depends on the brand and type. A doctor uses an applicator to quickly and easily place the device just under the skin on your arm or belly. It takes less than a minute and you may feel a small pinch, but there is typically no pain afterward.
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Last Modified: October 23, 2023
Terry TurnerSenior Financial Writer and Financial Wellness Facilitator
- Association for Financial Counseling & Planning Education (AFCPE®) member
- Holds six Health Literacy certificates from the CDC
- Emmy® Award winner
Edited By
Lee WilliamsSenior Financial Editor
Reviewed By
Aflak ChowdhuryMedicare Expert
10 Cited Research Articles
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- Amin, S. (2020, July 16). Does Medicare Cover Diabetes Supplies? Retrieved from https://www.medicalnewstoday.com/articles/does-medicare-cover-diabetic-supplies
- U.S. Centers for Medicare & Medicaid Services. (2018, August 16). Current Medicare Coverage of Diabetes Supplies. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE18011.pdf
- Doheny, K. (2017, November 7). Medicare to Cover Therapeutic CGM, Sets Criteria. Retrieved from https://www.endocrineweb.com/news/diabetes/57179-medicare-cover-therapeutic-cgm-sets-criteria
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Therapeutic Continuous Glucose Monitors. Retrieved from https://www.medicare.gov/coverage/therapeutic-continuous-glucose-monitors
