Does Medicare cover continuous glucose monitors? This is a common question for many Fort Lauderdale residents managing diabetes. With devices like the FreeStyle Libre and Dexcom offering real-time glucose tracking without the need for frequent finger pricks, CGMs have become an essential tool for diabetes care. But understanding Medicare’s coverage rules can be confusing.
Consider Lennon, a 72-year-old retiree in Fort Lauderdale. He struggled with sudden blood sugar drops and wanted a CGM for better management. When he asked his doctor, he was surprised to learn that Medicare does cover CGMs—but only if certain requirements are met. Many others in the area face the same uncertainty.
If you’re wondering whether Medicare will help pay for a CGM, you’re not alone. In this guide, we’ll explain the key requirements, the different types of coverage, and the benefits available in Fort Lauderdale. We’ll also reveal five surprising facts about Medicare’s CGM coverage that could save you time and money.
1. Yes, Medicare Covers Continuous Glucose Monitors—But There Are Requirements
Medicare does cover CGMs, but there are strict eligibility criteria. To qualify, a patient must meet all the following conditions:
- Have a diagnosis of diabetes (Type 1 or Type 2).
- Require insulin therapy or have frequent medication adjustments.
- Perform self-monitoring of blood glucose (SMBG) at least four times per day.
- Have a doctor’s prescription confirming that a CGM is medically necessary.
If you meet these requirements, Medicare will cover the cost of an approved CGM system, but the device must be obtained from a Medicare-approved supplier. The covered devices include:
Medicare will not cover CGMs used for general health tracking or non-prescription purposes. Additionally, the physician must document the patient’s need for a CGM in their medical records, and Medicare may require periodic re-evaluations to continue coverage.
Understanding these conditions is essential to avoid any delays or denials in coverage. If you’re unsure whether you qualify, contacting a Medicare-approved supplier can help clarify your eligibility.
2. Medicare Now Covers Both Traditional and “Non-Adjunctive” CGMs
Medicare’s coverage of continuous glucose monitors (CGMs) has evolved. Initially, coverage was limited to adjunctive CGMs, requiring confirmation with a blood glucose meter before making treatment decisions. These were supplementary tools. However, Medicare expanded coverage in 2021 and beyond to include non-adjunctive CGMs. These devices provide readings considered accurate enough to guide treatment decisions without routine fingerstick calibration, representing a significant shift in Medicare’s approach to CGM technology.
This change means that Medicare now covers CGMs that allow patients to:
- Check glucose levels without routine finger pricks.
- Receive real-time alerts for high or low blood sugar.
- Track trends and adjust insulin doses more effectively.
The Dexcom G6 and G7 and FreeStyle Libre 2 and 3 fall under this category, making them more accessible to Medicare beneficiaries. However, it’s important to note that some older CGM models still require finger stick calibration and may not be covered.
For Fort Lauderdale residents managing diabetes, this policy change represents a major step forward in making advanced CGM technology available through Medicare. If you previously thought Medicare wouldn’t cover your preferred CGM, it may be time to check again.
3. CGM Coverage Falls Under Medicare Part B, Not Part D
Many people mistakenly assume that CGMs are covered under Medicare Part D (Prescription Drug Coverage). However, CGMs are classified as Durable Medical Equipment (DME) and are covered under Medicare Part B.
This distinction affects how CGMs are obtained and paid for:
- Part B Coverage: Medicare pays 80% of the cost of an approved CGM once the Part B deductible is met.
- Patient Responsibility: The remaining 20% is out-of-pocket, unless the patient has a Medicare Supplement (Medigap) plan or a Medicare Advantage plan that covers the difference.
- Medical Supplier Requirement: CGMs must be obtained from a Medicare-approved durable medical equipment (DME) supplier, not a retail pharmacy (unless the pharmacy is also a certified supplier).
Understanding the Part B classification is important because many pharmacies do not process CGMs under Medicare. Instead, you’ll need to work with an approved medical supplier that can handle the Medicare billing process for you.
For patients in Fort Lauderdale, ensuring that their CGM supplier is Medicare-certified is essential to avoid paying full price for a covered device.
4. You Must Use a Medicare-Approved Supplier for CGM Coverage
Even if you meet all the medical requirements for CGM coverage, you must purchase the device through a Medicare-approved supplier to receive Medicare benefits. If you buy a CGM from an unapproved provider, Medicare will not reimburse you for the cost.
Medicare-approved suppliers:
- Handle the required paperwork and claims processing.
- Ensure that the CGM device meets Medicare’s standards.
- Offer support in case of coverage issues or claim denials.
If you purchase a CGM from a local pharmacy or online retailer that isn’t Medicare-certified, you may be responsible for the full out-of-pocket cost, which can be several hundred dollars per month.
Before placing an order, Fort Lauderdale residents should always check with the supplier to confirm that they are Medicare-enrolled and authorized to provide CGMs. This simple step can prevent unexpected expenses and ensure continued coverage.
5. Medicare Advantage Plans May Offer Additional Benefits
If you are enrolled in a Medicare Advantage Plan (Part C), your coverage for CGMs may differ from traditional Medicare. While Medicare Advantage plans must provide at least the same benefits as Original Medicare, some plans offer lower copays, reduced deductibles, or even full coverage for CGMs.
Key differences between Original Medicare and Medicare Advantage for CGM coverage include:
| Feature | Original Medicare (Part B) | Medicare Advantage (Part C) |
| Coverage Type | 80% coverage after deductible | Varies by plan (some offer full coverage) |
| Supplier Requirement | Must use a Medicare-approved DME supplier | May have in-network providers |
| Out-of-Pocket Costs | 20% coinsurance (unless covered by Medigap) | May have copays or no cost |
Medicare Advantage plans are offered by private insurance companies and may include additional benefits like wellness programs, telehealth services, and lower-cost CGMs. However, coverage policies can vary widely between plans.
If you’re on a Medicare Advantage plan, it’s important to contact your provider to confirm whether your plan offers additional CGM benefits and if there are specific network restrictions.
How Can Aptiva Medical Help You?
Navigating Medicare’s CGM coverage rules can be complex, but we make it easy. As a Medicare-approved supplier in Fort Lauderdale, Aptiva Medical helps patients get their CGMs covered through Medicare, handling all the paperwork and ensuring a hassle-free process.
We provide:
- Free eligibility verification for CGM coverage.
- Assistance in obtaining doctor prescriptions and documentation.
- Direct Medicare billing—no complicated forms for you.
- Convenient CGM delivery to your home.
If you need help accessing a FreeStyle Libre or Dexcom CGM through Medicare, call (800) 310-2568 today or visit us at 5249 NW 33rd Ave, Fort Lauderdale, FL 33309. Our team is ready to help you take control of your diabetes with the latest CGM technology.
Frequently Asked Questions
Can I use my smartphone to monitor my CGM data with Medicare coverage?
Yes, Medicare covers CGM systems if you use a durable medical equipment (DME) receiver to display your glucose data; you can also use a smartphone or other non-DME device alongside the receiver.
Does Medicare cover all brands of continuous glucose monitors?
Medicare covers FDA-approved CGM devices, including popular brands like Dexcom and FreeStyle Libre, as long as you meet the coverage criteria.
Do I need to be on insulin to qualify for Medicare CGM coverage?
No, Medicare now covers CGMs for individuals with diabetes who either use insulin or have a history of problematic hypoglycemia, even if they are not on insulin therapy.
How often do I need to see my doctor to maintain Medicare coverage for my CGM?
To continue Medicare coverage for your CGM, you must have a visit with your treating practitioner at least every six months to assess your CGM regimen and diabetes treatment plan.
