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Does Medicare cover continuous glucose monitors?


Yes. In fact, Medicare increased its coverage for continuous glucose monitors in April 2023. Introduced in 1999 to enable people with diabetes to regularly monitor their blood sugar levels, a continuous glucose monitor (CGM) attaches to your body to keep track of glucose levels in real time.

The Centers for Medicare & Medicaid Services expanded continuous glucose monitor coverage to any Medicare recipient prescribed insulin to treat diabetes, regardless of insulin type or amount. That change in 2023 made approximately 1.5 million more people eligible for the coverage.

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Medicare has been increasing several types of coverage for diabetes, offering prediabetes programs and implementing a $35 out-of-pocket insulin cap. These changes in coverage can help reduce the risk of developing more expensive conditions, such as chronic kidney disease, which costs Medicare almost $125 billion each year.

The previous rules limited continuous glucose monitor coverage to people who receive three or more injections of insulin a day or who have an insulin infusion pump.

How do continuous glucose monitors work?

The device inserts a tiny sensor under your skin, usually on your arm or abdomen, to measure glucose in fluid between your cells 24 hours a day. The sensor transmits information wirelessly to a wearable device or smartphone. Sometimes, a monitor comes as part of an insulin pump.

Continuous glucose monitors haven’t replaced finger-prick tests that register glucose levels only at the time of testing. Monitors continuously keep track of your glucose level and let you know if your blood sugar readings are trending high or low.

CGMs not only help you manage your blood sugar levels better but also guide your doctor in adjusting your insulin dose or diet. The monitor sends an alert if your reading reaches a certain level, but you may still need to do finger-stick tests to calibrate the device.

People with type 1 or type 2 diabetes who use a continuous glucose monitor have fewer instances of hypoglycemia, also known as low blood sugar, as well as a lower A1C — your average blood sugar levels over a three-month period — the American Diabetes Association says.

A1C levels are commonly used to diagnose prediabetes and diabetes. Higher readings are linked to diabetes complications, so managing your A1C level is important.

Medicare also covers blood sugar self-testing equipment, test strips and lancets for people with diabetes.

How did Medicare’s coverage change?

The government changed its CGM requirements to ensure that all Medicare recipients with diabetes who use Medicare-covered insulin can get a monitor, no matter the dose or frequency. It also expanded its coverage to people with diabetes who don’t take insulin but have a history of problematic low blood sugar.

In this case, to get coverage, you must have experienced:

  • More than one Level 2 hypoglycemic event with glucose of less than 54 milligrams per deciliter (mg/dL) — one-tenth of a liter, or 3 millimoles per liter (mmol/L) — that continues despite multiple attempts to adjust medications or modify the diabetes treatment plan. A mole is a unit of the amount of a substance; a millimole equals 0.001 moles.
  • Or a history of one Level 3 hypoglycemic event, glucose of less than 54mg/dL or 3.0mmol/L, characterized by an altered mental or physical state that requires assistance from another person for you to recover.
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What are Medicare’s requirements for coverage?

Medicare covers continuous glucose monitors as durable medical equipment under Part B with a 20 percent copayment. If you have a private Medigap plan to supplement Medicare coverage, it may cover that copayment.

To get coverage, you must be diagnosed with type 1 or type 2 diabetes and either be taking insulin or meet the hypoglycemia requirements. In addition, your doctor or other provider must:

  • Write a prescription and confirm that you or your caregiver has sufficient training using the glucose monitor.
  • Prescribe the monitor according to the federal Food and Drug Administration rules for its use.
  • Meet with you in person or through a Medicare-approved telehealth visit within six months before ordering a continuous glucose monitor to evaluate whether your diabetes is being controlled and determine if the other criteria are being met.

The device must be FDA-approved and purchased from a Medicare-approved supplier.

Keep in mind

There have been other promising developments for people with diabetes. As of Jan. 1, 2023, all Medicare Part D plans must cap out-of-pocket costs for covered insulin at no more than $35 a month. Not every Part D plan covers every insulin, so make sure the plan you’re considering covers the type of insulin you take.

For Medicare Part B, a similar cap took effect July 1, 2023. Part B covers insulin administered through pumps that aren’t disposable.

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