Does Medicare Cover Continuous Glucose Monitors for Diabetes?
- Does Medicare cover continuous glucose monitors? Learn who's eligible for monitors through Medicare, what additional supplies are covered and other ways to get a monitor.
In 2018, an estimated 13% of U.S. adults had diabetes. Among people aged 65 and over, that number rose to 26.8%. As older adults make up the bulk of the 63.3 million people enrolled in Medicare, it’s no surprise that the government is looking for better ways to help beneficiaries manage the condition.
Continuous glucose monitors use sensors under your skin to monitor blood glucose levels 24 hours a day. This information is sent to a wearable device or smartphone, giving users the ability to easily track blood sugar levels and determine dosing needs. These devices have resulted in better glycemic control, so they’re increasingly being recommended to people with diabetes. Find out if and how Medicare covers continuous glucose monitors.
Does Medicare Cover Continuous Glucose Monitors?
Original Medicare covers continuous glucose monitors through Part B of Medicare. In most cases, Medicare covers the monthly supplies for a monitor, which is a combination of sensors, transmitters and batteries depending on the brand. Although devices are covered, beneficiaries may have to pay copays or deductibles.
As Medicare Advantage must provide the same level of coverage as Original Medicare, these devices are also available to people on Medicare Advantage Plans. However, individual Medicare Advantage Plans may have different rules around costs, brands and the choice of where you can get services.
In the past, continuous glucose monitors were considered precautionary instead of medically necessary, which limited the number of people who could gain access to the technology. However, rules changed in 2021, allowing more enrollees to benefit from the devices.
What Brands Are Covered?
Most brands currently on the market are covered through Medicare. This includes Medtronic, Dexcom, Eversense and Freestyle Libre 1 and 2. In the past, Medicare only covered non-adjunctive monitors, which don’t require a finger stick glucose check to confirm findings. The new rules allow beneficiaries to also get adjunctive monitors, where users perform a finger stick test to ensure accuracy before making dosing decisions.
Who Qualifies for Continuous Glucose Monitors Through Medicare?
Continuous glucose monitors are only available to people who regularly take insulin. This includes those with Type 1 diabetes and some people with Type 2 diabetes. In particular, the monitors are intended to help those who have to frequently adjust their insulin dosage or regimen.
Monitors are currently not available to people who use minimal insulin, such as those who have background basal injections. It's also not available to people who are using non-insulin medication to control their condition. Your doctor can determine if you meet the Medicare requirements.
How Can I Get an Affordable Continuous Glucose Monitor?
People who aren’t eligible for a continuous glucose monitor through Medicare may still be able to access an affordable device. Start by checking your health insurance to see if monitors are covered.
If you can’t get a monitor through health insurance, you can try contacting the manufacturers. Many companies offer financial assistance to qualifying customers to help them access monitoring technology, including free trials and ongoing discounts for supplies.
Speak to your doctor if you want to try a continuous glucose monitor. Some doctors have stocks of supplies that they’re willing to share, and clinics may have professional continuous glucose monitors that they loan out. These are used for a short time to get a snapshot of your glucose data and gauge the effectiveness of your diabetes management.
Finally, you can look for an affordable supplier. More monitoring systems are becoming available through pharmacies, and these are generally less expensive than ordering direct through manufacturers.
Are Additional Diabetic Supplies Covered by Medicare?
Additional diabetic supplies are covered by Medicare, including test strips, traditional blood glucose meters, lancets and control solutions. Therapeutic shoes may also be available to people who have foot problems caused by diabetes.
Insulin and other glucose-controlling medications may also be available through Medicare but only through prescription drug coverage. To access prescription drugs, you must either get Medicare Part D or a Medicare Advantage Plan that includes prescription medications.