What Glucose Meter Does Medicare Cover?

Managing blood glucose levels is central to diabetes care. Individuals with diabetes rely on glucose meters and related supplies to monitor their condition. Medicare, the federal health insurance program for people aged 65 or older and certain younger people with disabilities, helps beneficiaries access these medical tools. Medicare covers various medical equipment and supplies, including glucose meters, which are essential for ongoing diabetes management.

Understanding Medicare Part B Coverage

Glucose meters and their associated supplies are categorized under Medicare Part B as Durable Medical Equipment (DME). DME is equipment that can withstand repeated use, serves a medical purpose, is typically only useful to someone who is sick or injured, is used in the home, and is expected to last for at least three years. Medicare Part B covers these items when deemed medically necessary by a healthcare provider.

Coverage extends to standard blood glucose monitors, which often require finger-prick tests, and continuous glucose monitors (CGMs). For CGMs, specific criteria must be met for coverage. Individuals must have a diabetes diagnosis and either be taking insulin or have a history of problematic low blood sugar (hypoglycemia). The prescribing doctor must confirm the device is prescribed according to Food and Drug Administration (FDA) indications and that the beneficiary, or their caregiver, has sufficient training to use it.

Recent updates expanded CGM coverage to include all Medicare recipients prescribed insulin for diabetes, regardless of insulin type or amount. Coverage also includes individuals with diabetes who do not take insulin but have a history of problematic low blood sugar events. These events are defined as more than one Level 2 hypoglycemic event (glucose less than 54 mg/dL) or one Level 3 hypoglycemic event (requiring assistance for recovery).

Medicare Part B covers essential testing supplies in addition to the meters. These include blood glucose test strips, lancets, lancet devices, and control solutions, used to verify the accuracy of the meter and strips. The quantity of supplies covered varies based on insulin use. For individuals using insulin, Medicare covers up to 300 test strips and 300 lancets every three months, along with one lancet device every six months.

If a person does not use insulin, Medicare covers up to 100 test strips and 100 lancets every three months, plus one lancet device every six months. If a healthcare provider determines additional supplies are medically necessary, Medicare may cover more than these standard quantities. Beneficiaries may need to maintain a record or log demonstrating the actual frequency of testing to support the need for increased supplies.

Navigating the Coverage Process

Obtaining a Medicare-covered glucose meter and supplies begins with a written order or prescription from a healthcare provider. This document should specify the patient’s diabetes diagnosis, the type of blood glucose equipment required, and the medical reason for its necessity. For instance, if a special monitor is needed due to vision problems, the doctor must explicitly state this in the prescription.

The prescription also indicates whether the patient uses insulin, how often blood glucose testing should occur, and the quantity of test strips and lancets needed for a one-month supply. Healthcare providers must document the medical necessity for the equipment in the patient’s medical record. A face-to-face consultation, which can be in-person or a Medicare-approved telehealth visit, must occur within six months before the prescription is issued.

After securing the prescription, obtain the equipment and supplies from a Medicare-enrolled or Medicare-approved supplier. These suppliers must meet specific operational and accreditation standards set by Medicare. They are responsible for submitting claims directly to Medicare; beneficiaries generally do not submit claims themselves.

To locate an approved supplier, beneficiaries can ask their doctor for recommendations or use the supplier search tool on Medicare.gov. Calling the Medicare helpline at 1-800-MEDICARE can also provide a list of approved suppliers. Ensuring the supplier is Medicare-approved and accepts assignment is important for managing out-of-pocket costs.

Costs and Financial Considerations

When Medicare Part B covers glucose meters and supplies, beneficiaries incur out-of-pocket costs. The first is the annual Medicare Part B deductible, set at $257 for 2025. Beneficiaries pay this amount before Medicare contributes to the cost of covered services and equipment.

After the deductible is met, Medicare Part B pays 80% of the Medicare-approved amount for durable medical equipment, including glucose meters and supplies. The beneficiary is responsible for the remaining 20% as coinsurance. This coinsurance applies to each purchase or rental of covered items.

A supplier accepting “assignment” is important. When a supplier accepts assignment, they agree to accept the Medicare-approved amount as full payment. This means they can only charge the beneficiary the 20% coinsurance and any unmet Part B deductible. If a supplier does not accept assignment, they may charge more than the Medicare-approved amount. The beneficiary could then be responsible for the difference, sometimes requiring upfront payment and waiting for Medicare reimbursement.

Medicare Supplement Insurance plans, or Medigap policies, can help reduce these out-of-pocket expenses. Medigap plans pay for some or all costs Original Medicare does not cover, such as the Part B coinsurance and deductible. While Medigap plans can lower a beneficiary’s financial responsibility, they involve separate monthly premiums.

Medicare Advantage Plans and Glucose Meter Coverage

Medicare Advantage Plans (Medicare Part C) are health insurance plans offered by private companies approved by Medicare. These plans must cover at least all benefits provided by Original Medicare Part A and Part B, including glucose meters and associated supplies. Individuals enrolled in a Medicare Advantage Plan will have coverage for these diabetes management tools.

Despite equivalent coverage, Medicare Advantage Plans administer benefits differently than Original Medicare. Network restrictions are a key difference. Many Medicare Advantage Plans operate with specific networks of doctors, hospitals, and suppliers, meaning beneficiaries may need to obtain glucose meters and supplies from providers within the plan’s network for coverage.

Cost-sharing structures also vary. Instead of the 20% coinsurance common with Original Medicare, beneficiaries might encounter copayments (a fixed dollar amount) for equipment and supplies, or different deductible amounts. Some plans may offer preferred brands for blood glucose monitors or have specific pharmacies from which supplies must be obtained for the lowest cost-share.

Another difference is the requirement for prior authorization for certain items, such as continuous glucose monitors. While Original Medicare does not require prior authorization for standard glucose meters, Medicare Advantage Plans might mandate it for CGMs, especially for individuals not on insulin or for specific models. This means the plan must approve coverage before the equipment is provided.

Beneficiaries enrolled in a Medicare Advantage Plan should review their plan’s Evidence of Coverage document or contact their plan directly. This provides details regarding network rules, cost-sharing amounts, prior authorization requirements, and preferred suppliers or brands for glucose meters and supplies. Some Medicare Advantage plans have expanded access for CGMs, allowing them to be obtained directly through pharmacies in addition to DME vendors.