Medicare Coverage for CGMs and Diabetes Care

Medicare coverage for diabetes can feel complicated, especially when you’re looking at continuous glucose monitors (CGMs) and newer tech.

The good news: once you understand which Medicare part covers what—and how eligibility works—you can make confident, cost‑smart choices.

Below, you’ll find a clear guide to what Medicare covers for diabetes care, how CGM coverage works, and step‑by‑step instructions to check your eligibility and get approved.

What Medicare Covers for Diabetes Care

Medicare Part B covers most outpatient diabetes care: doctor visits, diabetes screenings, lab tests, diabetes self‑management training (DSMT), medical nutrition therapy (MNT), durable medical equipment (DME) like external insulin pumps and CGMs, and supplies such as lancets and test strips. Medicare Part D generally covers prescription drugs—notably insulin that’s not used with a pump and other diabetes medications. Part A covers inpatient hospital care, and Medicare Advantage (Part C) plans include Parts A and B (often Part D too) with their own networks and rules.

Costs typically include the Part B deductible (if not already met) and 20% coinsurance for covered items and services, unless you have a Medigap policy or your Medicare Advantage plan sets a different copay. Using Medicare‑enrolled suppliers who accept assignment is critical to avoid unexpected bills.

Preventive services matter because they’re often covered at $0 with eligible risk factors: diabetes screenings (up to two per year for at‑risk beneficiaries), A1C and other lab tests as ordered, and annual foot and eye exams linked to diabetes complications. These can catch issues early and support better coverage decisions later, like when it’s time to consider a CGM.

Continuous Glucose Monitors (CGMs) Under Medicare

CGMs track glucose continuously through a small sensor, letting you see trends, get alerts, and make timely adjustments. Medicare covers FDA‑cleared CGMs and supplies under Part B as durable medical equipment when certain eligibility criteria are met.

Who qualifies for a CGM?

Diabetes diagnosis documented by your treating clinician.
Insulin treatment (any regimen—MDI or insulin pump) or a history of problematic hypoglycemia (for example, recurrent Level 2 hypoglycemia <54 mg/dL or at least one severe event requiring assistance), as documented in your chart.
Recent evaluation for diabetes management—typically an in‑person or telehealth visit within the prior six months before ordering the CGM.
Prescription for a CGM consistent with FDA indications, plus willingness to use the device as directed.
Medicare‑enrolled supplier or pharmacy that can dispense your specific CGM brand and accepts Medicare assignment.

Notably, Medicare no longer requires you to perform a set number of fingersticks per day to qualify. Your clinician’s documentation of insulin use or problematic hypoglycemia is key.

What’s covered?

CGM sensors and transmitters (and a receiver/reader if needed). Some systems use your smartphone as the receiver.
Training and follow‑up visits under Part B when medically necessary.
Common brands like Dexcom G7 and FreeStyle Libre 2/3 are widely covered when criteria are met; availability can vary by supplier and plan.

Coverage is under Part B, so coinsurance is typically 20% after the Part B deductible. If you have a Medigap plan, that coinsurance may be partly or fully covered. Medicare Advantage plans may require prior authorization and use specific in‑network suppliers.

How to check your CGM eligibility (step‑by‑step)

1) Confirm your diagnosis and treatment. Are you insulin‑treated, or do you have documented problematic hypoglycemia? If yes, you may meet core criteria.
2) Book a diabetes visit (in‑person or telehealth) if your last one was more than six months ago. Ask your clinician to update chart notes on insulin regimen, hypoglycemia history, and the medical need for a CGM.
3) Ask for a detailed prescription. It should name the CGM brand, frequency of sensor changes, and medical necessity.
4) Choose a Medicare‑enrolled supplier. Call your preferred CGM brand’s support line for a list of Medicare suppliers or check your plan’s directory. Confirm they accept assignment.
5) Verify plan rules. Original Medicare rarely needs prior authorization for CGMs; many Medicare Advantage plans do. If you’re on Part C, confirm network supplier, prior auth, and any copay.
6) Ensure paperwork is complete. Suppliers often request recent chart notes. Delays usually stem from missing documentation—ask them exactly what they need.
7) Track refill timing. Sensors must be dispensed at Medicare‑allowed intervals. Mark calendar reminders so you don’t run out.

Real‑world example

Dorothy, 72, on basal‑bolus insulin, had two recent daytime glucose readings below 54 mg/dL with symptoms. Her clinician documented these episodes and prescribed a Dexcom G7. Because she has Original Medicare and a Medigap plan, she paid $0 after her Part B deductible; a Medicare‑enrolled supplier shipped sensors every 30 days. Your experience may differ based on plan type and supplier network, but the documentation steps are the same.

Insulin, Pumps, and Other Diabetes Supplies

External insulin pumps are covered under Medicare Part B as DME when medically necessary. If you use an external pump, the insulin for that pump is also covered under Part B. In contrast, insulin not used with a pump is usually covered by Part D (or Part C if bundled through a Medicare Advantage plan).

Thanks to recent policy changes, many beneficiaries pay no more than $35 for a one‑month supply of each Part D‑covered insulin. Part B‑covered pump insulin has also been subject to similar monthly cost protections in recent years; check your plan’s current policies to confirm your exact out‑of‑pocket costs.

Blood glucose meters, test strips, and lancets are covered under Part B. Typical allowances differ for insulin‑treated and non‑insulin‑treated beneficiaries, but your clinician can document medical necessity for additional quantities if needed. Always use a Medicare‑enrolled supplier and keep receipts and delivery records.

Prevention and education you shouldn’t skip

Diabetes screenings: Up to two per year for at‑risk beneficiaries.
DSMT (Diabetes Self‑Management Training): Education to help you use devices like CGMs effectively.
MNT (Medical Nutrition Therapy): Work with a registered dietitian for personalized meal planning.
Eye and foot exams: Coverage for diabetic retinopathy and neuropathy monitoring helps catch complications early.

Costs and Ways to Save

Use Medicare‑enrolled suppliers who accept assignment. This keeps your cost to the Medicare‑approved amount and prevents balance billing.
Check prior authorization rules. Common with Medicare Advantage plans for CGMs and pumps.
Consider Medigap. With Original Medicare, Medigap can cover Part B coinsurance (often 20%).
Review Extra Help/LIS and State Savings Programs. If eligible, these can substantially reduce Part D drug costs and some premiums.
Stay in‑network. Advantage plans may require specific pharmacies or DME suppliers for CGMs, pumps, and strips.

How to Verify Your Coverage Today

For Original Medicare (Parts A and B)

Call 1‑800‑MEDICARE or log in to your Medicare account to confirm Part B DME coverage for your CGM brand.
Ask your clinician to send recent chart notes and a prescription to a Medicare‑enrolled supplier.
Confirm the supplier accepts assignment and verify your estimated 20% coinsurance after deductible.

For Medicare Advantage (Part C)

Check your plan’s evidence of coverage for DME and diabetes supplies.
Confirm network suppliers for your specific CGM brand and whether prior authorization is required.
Ask for a cost estimate (copay/coinsurance) for sensors, transmitters, and any receiver.

Common Pitfalls (and How to Avoid Them)

Missing the six‑month visit window. If your last diabetes management visit was too long ago, suppliers can’t process the order. Book a quick follow‑up.
Using a non‑enrolled supplier. Always confirm Medicare enrollment and assignment before ordering.
Incomplete documentation. Ask your clinician to note insulin regimen or hypoglycemia history, and explicitly state medical necessity for a CGM.
Switching brands mid‑year. Your plan or supplier may not support the new brand without new paperwork and approvals.
Ignoring refill timing. Medicare enforces shipping windows for sensors; set reminders.

Quick Answers

Does Medicare cover Dexcom G7 and FreeStyle Libre 3? Yes—if you meet Medicare’s CGM criteria and use a Medicare‑enrolled supplier that carries your brand.
Can I get both a CGM and test strips? Usually yes. Clinicians may still prescribe strips for calibrations or backups. Quantities depend on medical need and plan rules.
Are CGMs covered for prediabetes? No, you must have a diabetes diagnosis and meet Medicare’s criteria.
Do I need prior authorization? Often for Medicare Advantage plans; typically not for Original Medicare, though documentation is still required.

Bottom line: If you use insulin—or have documented problematic hypoglycemia—you likely qualify for a CGM under Medicare Part B. Start by scheduling a quick diabetes visit, getting a detailed prescription, and choosing a Medicare‑enrolled supplier. With the right steps and documentation, you can access technology that improves safety, time‑in‑range, and quality of life.