Does Medicare Cover Continuous Glucose Monitors?
- Get the facts about Medicare coverage of continuous glucose monitors (CGMs). Find out who qualifies for CGMs and how much you can expect to pay out of pocket.
The U.S. Centers for Disease Control and Prevention advises that regular blood sugar monitoring can improve the effectiveness of treatments for Type 1 and Type 2 diabetes and lower the risk of serious complications like blindness, heart attack and stroke. Continuous glucose monitors make it easier to keep tabs on your blood sugar levels throughout the day, and the most popular models are often covered by Medicare.
Does Medicare Cover Continuous Glucose Monitors?
Yes, Medicare typically covers the cost of continuous glucose monitors (CGMs). The devices are considered durable medical equipment under Medicare Part B. As a result, you will usually be responsible for only 20% of the cost of a CGM. Medicare pays for the rest. A Medigap plan may help you pay for some or all of the portion of the costs that you're responsible for.
What Are Continuous Glucose Monitors?
Continuous glucose monitors are devices that let you check your blood sugar without having to collect a blood sample each time. To use one, you insert a patch into the skin on the back of your arm. Sensors in the device track your blood sugar levels continuously. When you want to see your number, you hold a receiver up to the patch. Some CGMs have an app that turns your smartphone into a receiver. The app also stores your readings and can send them to your doctor if you wish.
CGMs offer many benefits, including:
- Reduced need for finger sticks
- Greater accuracy, as the devices are not typically affected by over-the-counter medications
- Easier tracking with mobile app
- Fewer low blood glucose emergencies because many devices warn you of out-of-range readings with alarms
Can I Stop Doing Finger Sticks If I Use a CGM?
With a CGM, you will still need to perform finger sticks occasionally. Traditional diabetes testing strips are used to calibrate continuous glucose monitors. You may also need to verify unusual readings with a traditional glucose monitor.
Who Qualifies for a Continuous Glucose Monitor?
Medicare will cover CGMs for people who:
- Have an established diagnosis of Type 1 or Type 2 diabetes
- Are currently using a traditional blood glucose monitor
- Must check their blood sugar a minimum of four times daily
- Use insulin to treat diabetes and require frequent adjustments to their regimens or have a subcutaneous insulin infusion pump
- Receive training from their doctors on how to use CGMs
How Do I Get Medicare to Cover CGM?
For Medicare to cover a continuous glucose monitor, you need to:
- Pay your Part B premium and the 20% of the cost that you're responsible for
- Have already met your Part B deductible
- Get a prescription for a CGM from a Medicare-participating doctor
- Purchase your CGM from a Medicare-approved provider
- See your doctor for checkups once every six months
Will Medicare Cover a CGM If I Use My Smartphone to Check My Numbers?
A smartphone is not considered durable medical equipment. As a result, Medicare Part B won't cover a CGM unless you use a receiver to check your levels. You can use your smartphone to review data and trends or to send your results to your doctor.
Does Medicare Pay for a CGM Device?
Provided you buy the CGM from an approved supplier and meet eligibility requirements, Medicare will usually pay for 80% of the cost of a CGM receiver through Part B coverage.
Does Medicare Pay for CGM Accessories and Supplies?
Yes, Medicare generally pays 80% of the cost of CGM accessories and supplies. Under the guidelines, Medicare Part B covers:
- Patch refills based on the recommended replacement schedule. For example, if you use a CGM that requires a new patch every 14 days, Medicare will pay for two patches every 28 days.
- Up to 300 test strips every three months if you are being treated with insulin
- Up to 300 lancets every three months if you are being treated with insulin
Medicare Part D may also cover:
- Alcohol swabs
- Insulin pens and inhaled insulin devices
If your doctor determines that testing more often is medically necessary, Medicare may pay for additional test strips and lancets. Medicare usually won't cover the automatic shipment of diabetes testing supplies.
What CGMs Are Covered by Medicare?
Some CGMs typically covered by Medicare include:
- FreeStyle Libre 14-Day
- FreeStyle Libre 2
- Dexcom G6
How Much Do CGMs Cost?
The average retail prices for CGMs vary by model. GoodRx reports that the Dexcom G6 retails for a little over $400, and the retail price of the FreeStyle Libre 2 is around $130. In addition to the cost of the device, you'll need to pay for accessories and supplies. A study published in US Endocrinology estimates that the overall cost of using the FreeStyle Libre 14-Day System for 12 months is approximately $1,600.