Does Medicare Cover the Freestyle Libre?
- Get the facts about Medicare coverage for the FreeStyle Libre. Learn about the cost of the continuous glucose monitor and when it is covered for diabetes treatment.
The U.S. Centers for Disease Control and Prevention estimates that one out of every 10 adults in the United States suffers from diabetes and that approximately 90% to 95% have type 2 diabetes. If you're one of the more than 34 million Americans living with the disease, blood sugar monitoring is likely a part of your daily routine. Although essential to managing diabetes, traditional blood glucose monitors come with hassles and pain of frequent finger sticks. The FreeStyle Libre simplifies monitoring and is often covered by Medicare.
What Is the FreeStyle Libre?
The FreeStyle Libre is a continuous glucose monitor or CGM. With the monitor, you use a device called an inserter to press a patch partially into the skin of your upper arm. Adhesive helps keep the patch in place throughout the day. Once in place, the sensor regularly checks your glucose readings and records the data. To check your blood sugar, you hold a reader or a smartphone with an app installed up to the sensor. The reading then displays for your review. A single patch is worn for 10 to 14 days, and then, you replace it with a fresh one.
What Are the Benefits of the FreeStyle Libre?
Compared to traditional glucose monitors, the FreeStyle Libre offers numerous advantages, such as:
- Less need for finger sticks
- Easy placement of patches
- Improved accuracy with over-the-counter medications like acetaminophen
- Fast results any time of the day
- Simpler monitoring
- Improved tracking with trends for the last eight hours displayed
- Prompt notification of out-of-range readings with alarms
Who Is Eligible for the FreeStyle Libre?
The FDA has approved the FreeStyle Libre for people over the age of four who have type 1 or type 2 diabetes. Your doctor can help you determine whether the CGM is right for you. A prescription from a medical professional is needed to purchase the device.
How Much Does FreeStyle Libre Cost Out of Pocket?
GoodRx reports that the cost of the FreeStyle Libre ranges from $120 to $131. The amount you would pay out of pocket varies based on where you live and which retailer you buy from. In addition to the device, you will need to purchase additional supplies on a monthly basis. A study published in the journal US Endocrinology found that the overall cost of using the FreeStyle Libre 14-Day System for one year is $1,602.76.
Does Medicare Cover the FreeStyle Libre?
Medicare covers CGMs like the FreeStyle Libre under the durable medical equipment (DME) portion of Medicare Part B, provided you meet eligibility criteria. If you qualify for coverage for the monitor, Medicare will also cover your supplies within certain limits.
How Much Will the FreeStyle Libre Cost Me With Medicare?
If you are eligible, Medicare Part B will typically pay for 80% of the cost of the FreeStyle Libre and 80% of the cost of supplies once your deductible is met. A Medicare Advantage plan would likely pay for all or part of what Medicare doesn't.
How Do I Get Medicare to Cover a CGM?
For Medicare to cover the cost of FreeStyle Libre, you must:
- Continue to pay your Part B premium
- Have already paid your Part B deductible
- Receive a prescription for the device from a physician who accepts Medicare
- Buy the CGM from a supplier who accepts Medicare
- Cover whatever portion of the costs that Medicare doesn't
What Are the Qualifications for Medicare Coverage for CGMs?
Under the guidelines established by Medicare, the following statements must apply to you to qualify for coverage for a CGM:
- You have an established diagnosis of diabetes.
- You are currently using a blood glucose monitor.
- Your doctor recommends that you check your blood sugar four or more times every day.
- You use insulin to control diabetes, and your regimen needs to be adjusted regularly.
- You have been seeing the doctor who will prescribe the CGM for at least 6 months.
- Your doctor has taught you how to properly use the device.
For coverage to continue, you will need to see the prescribing doctor for checkups every 6 months. In addition, you must use the receiver to display your glucose readings. You may use the smartphone app in addition to the receiver to review data or send readings to your medical provider; however, you can't only use your smartphone. This rule exists because a smartphone is not classified as durable medical equipment.
Does Medicare Cover CGM Equipment and Accessories?
Yes, Medicare Part B pays for 80% of the cost of the accessories required to use the device, including the patches. Medicare does cap the number of testing strips and lancets that it will cover. If you use insulin, the general limit is 300 test strips and 300 lancets per three-month period. When a doctor deems that increased testing is medically necessary, Medicare may approve payments for supplies in excess of the established limit.
Will Medicare Pay to Have My Supplies Shipped Automatically?
Unfortunately, Medicare doesn't cover the cost of automatic shipments of supplies.
Where Do I Get the FreeStyle Libre?
The FreeStyle Libre is available from many suppliers, but you'll need to be certain that the one you choose participates in Medicare. Use the supplier finder tool to confirm participation before you buy.
How Do I Get FreeStyle Libre for Free?
Abbott, the manufacturer of FreeStyle Libre, sometimes advertises a 14-day free trial of the device; however, this program is not open to people who have Medicare coverage. It is only available for individuals covered solely under private insurance plans.
What Other Diabetes Supplies Does Medicare Cover?
Medicare Part B typically covers:
- Lancets, test strips and other supplies used to check blood sugar readings
- Insulin pumps
- Therapeutic orthotics for diabetic foot care
- Diabetes prevention programs
- Semi-annual foot exams
- Annual glaucoma screenings
- Nutrition counseling
- Annual wellness visits
- Laboratory tests like A1C and fasting glucose blood work
Medicare Part D usually covers:
- Oral diabetes drugs
- Medical supplies like syringes and alcohol pads