Does Medicare Pay for Continuous Glucose Monitors?

Continuous Glucose Monitors (CGMs) offer individuals with diabetes a way to track their blood glucose levels throughout the day without frequent fingersticks. These devices provide real-time data, which can help in managing glucose fluctuations and making informed treatment decisions. Medicare does provide coverage for Continuous Glucose Monitors, recognizing their utility in diabetes management.

Medicare Eligibility for CGM Coverage

Medicare covers Continuous Glucose Monitors under Part B as Durable Medical Equipment (DME). To qualify for coverage, an individual must have a diagnosis of diabetes and meet specific criteria focusing on medical necessity.

Coverage is generally provided if the individual is treated with insulin. Alternatively, those not on insulin may still qualify if they have a history of problematic hypoglycemia. Problematic hypoglycemia is defined as recurrent Level 2 hypoglycemic events (glucose below 54 mg/dL) that persist despite efforts to adjust medication or treatment, or at least one Level 3 hypoglycemic event (glucose below 54 mg/dL) requiring third-party assistance due to an altered mental or physical state.

Additionally, the prescribing healthcare professional must conclude that the beneficiary, or their caregiver, has sufficient training to use the prescribed CGM. A visit with the treating practitioner, either in-person or via Medicare-approved telehealth, must have occurred within six months prior to ordering the CGM to evaluate diabetes control and ensure the CGM is appropriate for improving glycemic control.

Covered CGM System Components

Medicare coverage for Continuous Glucose Monitors extends to the complete system, including the device and its necessary disposable supplies, such as sensors.

Medicare covers both therapeutic and non-therapeutic CGMs that meet Food and Drug Administration (FDA) approval and Medicare criteria. Therapeutic CGMs are approved for making treatment decisions without a confirmatory fingerstick blood glucose reading. Non-therapeutic CGMs may still be covered, but they might require verification of readings with a standard blood glucose monitor before treatment decisions are made. Medicare covers CGM supplies only if a durable medical equipment (DME) receiver is also used to display the data, even if a smartphone can display it.

Steps to Obtain Medicare Coverage

Obtaining Medicare coverage for a Continuous Glucose Monitor begins with a prescription from a healthcare professional who manages the individual’s diabetes. This physician must document the medical necessity, which includes details supporting the need for a CGM, and confirm that the individual has received sufficient training to use the device.

The CGM must be obtained from a Medicare-enrolled Durable Medical Equipment (DME) supplier. These suppliers handle the billing process directly with Medicare. They will submit the necessary claims and may coordinate any prior authorization requirements, which some Medicare Advantage plans may require, especially for non-Type 1 diabetes diagnoses.

Your Financial Responsibility

When Medicare covers a Continuous Glucose Monitor, beneficiaries incur out-of-pocket costs. CGMs are covered under Medicare Part B, and the annual Part B deductible applies. For 2025, the annual deductible for Medicare Part B beneficiaries is $257.

After the deductible is met, Medicare generally pays 80% of the Medicare-approved amount for durable medical equipment, including CGMs. The beneficiary is responsible for the remaining 20% coinsurance. While Original Medicare follows these cost-sharing rules, Medicare Advantage (Part C) plans may have different cost structures, such as varying copayments or network requirements. These plans must provide at least the same level of coverage as Original Medicare, though specific out-of-pocket expenses can differ.