Continuous glucose monitors (CGMs) have revolutionized the way individuals manage their blood sugar levels, offering real-time tracking and greater insights into glucose trends. While CGMs are commonly associated with diabetes management, many people with prediabetes are curious whether they, too, can benefit from this technology. A common question arises: does insurance cover CGM for prediabetes? Alongside this query, several misconceptions have emerged. This article sheds light on the truth and debunks five common myths surrounding CGM coverage for prediabetes.
Understanding CGMs and Prediabetes

Before diving into the myths, it’s important to understand what CGMs are and their relevance to prediabetes.
A CGM is a small wearable device that tracks glucose levels continuously throughout the day and night. It provides valuable data about blood sugar fluctuations, helping users make informed decisions about diet, exercise, and other lifestyle factors. For individuals with prediabetes—when blood sugar levels are higher than normal but not yet at the diabetic threshold—a CGM can offer critical insights to help prevent the progression to type 2 diabetes.
Now, let’s separate fact from fiction regarding CGM coverage for prediabetes.
Myth 1: Insurance Never Covers CGMs for Prediabetes
Fact: While it is less common for insurance to cover CGMs for prediabetes compared to diabetes, it is not impossible. Coverage largely depends on the specific insurance provider, policy, and individual medical necessity.
Insurance companies often require documentation from a healthcare provider to justify the need for a CGM. For individuals with prediabetes, demonstrating risk factors such as severe insulin resistance, frequent hypoglycemic episodes, or other complications can increase the likelihood of coverage. Some policies even consider CGM coverage as part of preventative health measures.
Tip: Speak with your doctor about your medical history and ask them to provide a strong case for why a CGM is essential for your care. Insurance companies are more likely to approve coverage if there is clear evidence of benefit.
Myth 2: CGMs Are Only for People with Type 1 Diabetes
Fact: CGMs were initially designed for individuals with type 1 diabetes, but their use has expanded significantly. People with type 2 diabetes, gestational diabetes, and even prediabetes can benefit from these devices.
For prediabetes, CGMs allow individuals to identify how specific foods, exercise, and stress impact their blood sugar levels. While not as widely prescribed for prediabetes, healthcare providers increasingly recognize their value in early intervention and prevention of full-blown diabetes.
Some insurance providers are beginning to include CGMs for prediabetes under preventative care initiatives, emphasizing the long-term cost savings associated with preventing diabetes-related complications.
Myth 3: CGMs Are Too Expensive to Be Worth It Without Insurance
Fact: It’s true that CGMs can be pricey without insurance coverage, but options exist to make them more affordable. A CGM system typically costs between $100 and $300 per month, depending on the brand and specific features. However, discounts, manufacturer programs, and healthcare spending accounts can help offset these costs.
Many CGM manufacturers, such as Dexcom and FreeStyle Libre, offer discount programs or financial assistance to eligible patients. Some pharmacies also have direct-to-consumer pricing that can be lower than expected.
Tip: If your insurance doesn’t cover CGMs for prediabetes, consider reaching out to the manufacturer to inquire about savings programs or talking to your doctor about samples or trial options.
Myth 4: Using a CGM for Prediabetes Is Overkill
Fact: Monitoring glucose levels in prediabetes is far from overkill. In fact, CGMs can play a pivotal role in reversing prediabetes or preventing its progression. Unlike traditional fingerstick methods, CGMs provide continuous data, making it easier to identify patterns and triggers.
For instance, CGMs can reveal hidden glucose spikes after meals or during stress, which are often missed with periodic testing. This information empowers individuals to make targeted lifestyle changes, such as altering meal timing, choosing different foods, or incorporating specific exercises to regulate glucose.
While insurance providers may hesitate to approve CGMs for prediabetes, the long-term benefits of preventing type 2 diabetes can justify the investment. Preventative care is often less expensive than managing chronic conditions in the long run.
Myth 5: You Don’t Need a Doctor to Get a CGM
Fact: Although some CGMs are available for direct purchase without a prescription, involving a healthcare professional is crucial for optimizing their use—especially if you’re seeking insurance coverage.
Doctors can provide guidance on how to interpret the data and adjust lifestyle habits effectively. They can also advocate for insurance approval by documenting medical necessity. Some insurance companies will only approve CGM coverage with a doctor’s prescription and supporting evidence, such as blood test results indicating prediabetes.
Additionally, healthcare providers can help identify which CGM system is best suited for your needs. For example, some systems offer alarms for high or low blood sugar, while others focus more on data tracking and integration with mobile apps.
Tip: Always consult with a doctor before starting a CGM to ensure you’re using it correctly and getting the most out of the device.
How to Improve Your Chances of Insurance Coverage for a CGM

If you have prediabetes and believe a CGM could benefit you, here are actionable steps to improve your chances of insurance coverage:
- Document Medical Necessity: Work with your doctor to create a detailed case explaining why a CGM is essential for managing your prediabetes.
- Understand Your Policy: Review your insurance plan’s terms and look for preventative care or diabetes management provisions.
- Appeal Denials: If your initial request is denied, don’t hesitate to file an appeal. Many denials are overturned upon further review.
- Explore Flexible Spending Accounts (FSAs) or Health Savings Accounts (HSAs): These accounts can help cover the cost of a CGM if insurance doesn’t.
- Stay Informed: Insurance policies and coverage criteria change over time. Stay up to date on any new developments or guidelines.
Conclusion
The question “does insurance cover CGM for prediabetes?” doesn’t have a straightforward answer yet, but the landscape is evolving. While coverage isn’t guaranteed for everyone, it’s not entirely out of reach. By understanding the myths and facts about CGMs for prediabetes, you can make informed decisions and take steps to advocate for coverage or explore alternative options.
CGMs are powerful tools that can help individuals with prediabetes take control of their health and potentially prevent the progression to type 2 diabetes. Whether through insurance or out-of-pocket means, the investment in a CGM can have life-changing benefits, offering real-time insights and empowering proactive lifestyle changes.
How Aptiva Medical Can Help You
At Aptiva Medical, we’re committed to helping you take control of prediabetes with continuous glucose monitoring (CGM). CGMs provide real-time insights into your blood sugar, empowering you to make informed lifestyle choices and prevent the progression to type 2 diabetes. Our team works with your healthcare provider to determine if a CGM is right for you and simplifies the process of navigating insurance coverage.
We understand that insurance for CGMs with prediabetes can be challenging, and we’re here to make it easier. From documenting medical necessity to exploring affordable options, Aptiva Medical provides personalized support to ensure you get the care and technology you need. Take the first step toward better health—contact us today!