What s the Copay for a Sensor for a Freestyle Continuous Glucose Monitor on Medicare
Does Medicare Cover Therapeutic Continuous Glucose Monitors?
Medicare covers therapeutic continuous glucose monitors and their necessary supplies. The devices replace blood sugar monitors and can be used to make diabetes treatment decisions such as changes in your diet or your insulin dosage.
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Terry Turner
Terry Turner
Senior Financial Writer and Financial Wellness Facilitator
Terry Turner has more than 30 years of journalism experience, including covering benefits, spending and congressional action on federal programs such as Social Security and Medicare. He is a Certified Financial Wellness Facilitator through the National Wellness Institute and the Foundation for Financial Wellness and a member of the Association for Financial Counseling & Planning Education (AFCPE®).
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- Edited By
Lee Williams
Lee Williams
Senior Financial Editor
Lee Williams is a professional writer, editor and content strategist with 10 years of professional experience working for global and nationally recognized brands. He has contributed to Forbes, The Huffington Post, SUCCESS Magazine, AskMen.com, Electric Literature and The Wall Street Journal. His career also includes ghostwriting for Fortune 500 CEOs and published authors.
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- Published: May 26, 2021
- Updated: September 21, 2022
- 3 min read time
- This page features 9 Cited Research Articles
Therapeutic CGM Coverage at a Glance
| Medicare Plan | Therapeutic CGM Coverage |
|---|---|
| Part A (Inpatient) | N/A |
| Part B (Outpatient) | Covers 80% of therapeutic continuous glucose monitor and associated supply costs once you meet your Part B deductible. |
| Part C (Medicare Advantage) | Coverage mirrors Part B. Select plans may offer additional benefits. |
| Part D (Prescription Drugs) | N/A |
| Supplemental Insurance | Can help cover out-of-pocket costs related to CGMs. Coverage varies by plan. |
Medicare Coverage for Therapeutic CGM
Medicare Part B covers therapeutic continuous glucose monitors (CGM) such as the Freestyle Libre 2 and the Dexcom G6 for people with diabetes.
Medicare covers therapeutic continuous glucose monitors as durable medical equipment (DME). You will be responsible for your Medicare Part B deductible and 20 percent of the Medicare-approved cost. Medicare will cover the other 80 percent after you meet your deductible.
Before You Decide
Make sure your CGM supplier is enrolled in Medicare and accepts the Medicare-approved price for the device and its supplies. If not, the supplier may charge you any price and Medicare will not pay.
A Medigap policy — also called Medicare Supplement insurance — can cover some of your out-of-pocket costs for the Medicare Part B deductible and coinsurance. Additionally, Medicare Advantage plans are required to cover everything included in Medicare Part A and B coverage but may offer additional benefits.
Both Medigap and Medicare Advantage plans are sold by private insurers. Your plan's administrator can verify your policy's coverage of therapeutic CGM.
Medicare Eligibility for a Therapeutic CGM
A therapeutic CGM is a medical device approved by the U.S. Food and Drug Administration as a replacement for home blood sugar monitors. It provides you and your doctor with the medically necessary information to make diabetes treatment decisions, such as changes in diet and your insulin dosage.
To qualify for a therapeutic CGM, you must be undergoing treatment for diabetes and meet certain other criteria.
To be eligible for a therapeutic CGM under Medicare, you must meet the following requirements.
- You are using insulin to treat Type 1 or Type 2 diabetes.
- You need to check your blood sugar four or more times per day.
- You must use an insulin pump or receive three or more insulin injections per day.
- You must make routine, in-person visits to your doctor.
- Your doctor has determined that you meet all Medicare eligibility requirements.
The decision between a therapeutic CGM or a traditional monitor is one you should make after talking to your doctor. A therapeutic CGM may be a better option if you use insulin and frequently change your dosage.
Medicare Coverage of Therapeutic CGM Supplies
Medicare Part B medical insurance covers maintenance supplies for durable medical equipment — such as a therapeutic CGM — that ensure the equipment works properly.
Medicare-covered therapeutic CGM supplies include:
- Test strips
- Lancets
- Lancing devices
- Glucose control solutions
- Other related supplies necessary for the proper operation of the therapeutic CGM
Medicare Part B may limit how often or how many supplies you can buy at one time. For example, insulin users are able to get up to 100 test strips and lancets per month. Patients who don't use insulin are limited to roughly a third of that amount.
Medicare does not cover some diabetes supplies, such as syringes, needles and alcohol swabs.
Last Modified: September 21, 2022
9 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2022, June). Medicare Coverage of Diabetes Supplies, Services and Prevention Programs. Retrieved from https://www.medicare.gov/Pubs/pdf/11022-LE-Medicare-Coverage-of-Diabetes.pdf
- Dexcom. (2022, January 31). Is Dexcom Covered by Medicare? Retrieved from https://www.dexcom.com/faqs/medicare
- U.S. Centers for Medicare & Medicaid Services. (2020, December). Medicare Coverage of Diabetes Supplies, Services and Prevention Programs. Retrieved from https://www.medicare.gov/Pubs/pdf/11022-Medicare-Diabetes-Coverage.pdf
- Melillo, G. (2020, October 29). CMS Proposed New Rules for CGM Coverage Among Medicare Beneficiaries. Retrieved from https://www.ajmc.com/view/cms-proposes-new-rules-for-cgm-coverage-among-medicare-beneficiaries
- U.S. Centers for Medicare & Medicaid Services. (2020, October 27). New CMS Proposals Streamline Medicare Coverage, Payment and Coding for Innovative New Technologies and Provide Beneficiaries with Diabetes Access to More Therapy Choices. Retreived from https://www.cms.gov/newsroom/press-releases/new-cms-proposals-streamline-medicare-coverage-payment-and-coding-innovative-new-technologies-and
- Amin, S. (2020, July 16). Does Medicare Cover Diabetes Supplies? Retrieved from https://www.medicalnewstoday.com/articles/does-medicare-cover-diabetic-supplies
- U.S. Centers for Medicare & Medicaid Services. (2018, August 16). Current Medicare Coverage of Diabetes Supplies. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE18011.pdf
- Doheny, K. (2017, November 7). Medicare to Cover Therapeutic CGM, Sets Criteria. Retrieved from https://www.endocrineweb.com/news/diabetes/57179-medicare-cover-therapeutic-cgm-sets-criteria
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Therapeutic Continuous Glucose Monitors. Retrieved from https://www.medicare.gov/coverage/therapeutic-continuous-glucose-monitors
Source: https://www.retireguide.com/medicare/services/durable-medical-equipment/therapeutic-continuous-glucose-monitors/
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