Yes. Under certain conditions, Medicare will cover a continuous glucose monitor (CGM) - and Medicare specifically notes:
“If your doctor [primary care physician] determines that you meet all the coverage requirements, Medicare covers continuous glucose monitors and related supplies [(sensors and transmitters)] for making diabetes treatment decisions, (like changes in diet and insulin dosage).”
What is required to get coverage for a CGM?
Medicare states that,
"Medicare may cover a continuous glucose monitor (receiver) and related supplies (sensors and transmitters) if your doctor says you meet all the requirements for Medicare coverage
The continuous glucose monitor requirements include:
- You have diabetes mellitus,
- You take insulin or have a history of problems with low blood sugar,
- Your doctor has given you a prescription for testing supplies and instructions on how often to test your blood glucose, and
- You or your caregiver have been trained to use a continuous glucose monitor as
prescribed by your doctor.
You must also make routine in-person or Medicare-approved telehealth visits with
your doctor."
What is a CGM?
A Continuous Glucose Monitor automatically measures the level of glucose
in a person and indicates whether the glucose level is rising or
falling. More importantly, the CGM will alert the user when their
glucose falls below a safe level. The CGM can also show how a person's
glucose levels change over time so a CGM user can better understand how
their lifestyle (diet and exercise) affects their glucose level. A CGM
works by having a very small (painless) sensor placed under the skin
that monitors glucose levels and transmits this information back to a
reader or a smartphone.
The cost of a CGM
If you meet the requirements for a Continuous Glucose Monitor, the cost of the CGM may depend on your healthcare coverage.
- If you have original Medicare Part B, the CGM will be covered as Durable Medical Equipment (DME) with 20% cost sharing (you pay 20% of the cost) after meeting the Part B deductible.
- If you are eligible for your state Medicaid program, the coverage requirements for a CGM will depend on your state - and you can contact a local Medicaid office for more details.
- If you are enrolled in a Medicare Advantage plan (MA or MAPD), you can speak with your plan's Member Services department for more information about CGM coverage. You may find that the Medicare Advantage plan provides coverage that is similar to the original Medicare Durable Medial Equipment 20% coinsurance.
What if you cannot meet the CGM eligibility requirements?
There may still be other ways to benefit from a CGM. As noted by the American Academy of Family Physicians Foundation (AAFP), you still may be able to use a:
(1) Professional CGM (owned by the professional healthcare practice and available for use),
(2) Self-pay for a CGM, or
(3) Sample or Trial CGM (possibly available from the CGM manufacturer or GoodRx.com or SingleCare.com).
To learn more about coverage of a Continuous Glucose Monitor. . .
To learn more about the coverage of a Continuous Glucose Monitor, you can speak with a Medicare representative by calling toll-free
1-800-633-4227 (1-800-Medicare) - TTY users can call 1-877-486-2048.
Once connected, please explain your situation to a Medicare
representative and ask the representative to help you learn more about
the coverage of a continuous glucose meter.
And, you can read more here:
(https://www.aafp.org/content/dam/AAFP/documents/patient_care/nrn/no-personal-cgm-coverage-handout.pdf
https://www.aafp.org/family-physician/patient-care/care-resources/continuous-glucose-monitoring.html#)
Sources include:
https://www.medicare.gov/publications/11022-medicare-coverage-of-diabetes-supplies-services-and-prevention-programs.pdf
https://www.medicare.gov/coverage/therapeutic-continuous-glucose-monitors
https://www.medicare.gov/coverage/blood-sugar-monitors
https://www.medicare.gov/Pubs/pdf/11022-Medicare-Diabetes-Coverage.pdf
*(June 2023 "The [CGM] requirements include the need to:
Frequently check your blood sugar (4 or more times a day), and . . ..")
https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33822
*(see Revision 8 - R8 07/18/21 "Removed: Four times or more per day testing with blood glucose monitor as prerequisite for CGM coverage")
https://www.jdrf.org/blog/2021/07/23/on-medicare-accessing-cgms-just-got-easier/
https://www.aafp.org/family-physician/patient-care/care-resources/continuous-glucose-monitoring.html