Medicare now covers continuous glucose monitors for many people with diabetes. Here's who qualifies.
Who qualifies for a CGM under Medicare?
Medicare Part B covers continuous glucose monitors (CGM) and related supplies as durable medical equipment for people with diabetes who meet Medicare's criteria. Generally, you may qualify if you're being treated with insulin, or if you have a history of problematic (recurrent) low blood sugar episodes, even without insulin use. Your doctor must document that you meet the requirements and prescribe the device. Medicare has expanded CGM access in recent years, so more people now qualify than before. You typically pay 20% of the Medicare-approved amount after your Part B deductible, using a Medicare-enrolled supplier. Call 1-800-MEDIGAP at 1-800-633-4427 to check if you qualify.
What's covered and what you'll pay
When you qualify, Medicare covers the CGM device and the ongoing supplies, like sensors and transmitters, needed to use it. Under Original Medicare you pay 20% of the Medicare-approved amount after your Part B deductible. Because CGM supplies are ongoing, that 20% recurs, so a Medigap (Medicare Supplement) plan that covers Part B coinsurance can meaningfully reduce your costs over time. Some Medicare Advantage plans cover CGMs with their own cost-sharing. Coverage requires a prescription and a supplier enrolled in Medicare. To confirm your CGM coverage and find ways to lower your costs, call 1-800-MEDIGAP for free help.