CGM Medicare Coverage — Eligibility Requirements & What's Covered

Hello. If you are on Medicare and considering a continuous glucose monitor, understanding your coverage before you order is essential. This guide explains who qualifies, what is covered, and how Medicare categorizes CGM devices. Step 1: Understand how Medicare categorizes CGM devices. Medicare divides CGMs into two categories that determine how coverage works. Therapeutic CGMs — also called iCGMs — are used to make insulin dosing decisions without a confirmatory fingerstick. These include the Dexcom G6, Dexcom G7, FreeStyle Libre 2, FreeStyle Libre 3, and Medtronic Guardian 4. Non-therapeutic CGMs require a confirmatory fingerstick before acting on readings and are covered differently. Step 2: Check if you meet the primary eligibility criteria. To qualify for Medicare CGM coverage under Part B, you must: have a diagnosis of diabetes; be treated with insulin — either multiple daily injections or insulin pump therapy; and have a face-to-face appointment with your doctor within 6 months of ordering the CGM. Medicare does not currently cover CGM for patients who manage diabetes with oral medications alone. Step 3: Understand Part B vs. Part D coverage. Therapeutic CGMs — including the devices listed above — are covered under Medicare Part B as Durable Medical Equipment. This means the device and sensors go through a DME supplier, and Medicare pays 80% of the approved cost after your Part B deductible. Your Medicare Supplement or Medigap plan typically covers the remaining 20%. Step 4: Know what is covered under Part B. Medicare Part B covers the CGM receiver or transmitter as durable medical equipment, sensors on a regular monthly supply schedule, and a limited number of lancets and test strips for confirmatory fingerstick testing when using a therapeutic CGM. Step 5: Check your Medicare plan for insulin pump CGM integration. If you use an insulin pump, Medicare may cover the CGM as part of an integrated pump system under separate coverage rules. Contact your DME supplier or Medicare plan to determine which coverage path applies to your pump model. Step 6: Confirm your doctor has the documentation ready. Your prescriber needs to document in your medical record: your diabetes diagnosis, your current insulin regimen, your history of glucose testing frequency, and a face-to-face visit within 6 months. Without complete documentation, your DME supplier cannot bill Medicare and your claim may be denied. Step 7: Understand quantity limits. Medicare approves one CGM receiver per patient for the expected device lifespan, typically one to three years. Sensors are covered on a monthly supply schedule based on the sensor wear period. For example, FreeStyle Libre 14-day sensors are covered at 2 sensors per month. Dexcom G7 10-day sensors are covered at approximately 3 sensors per month. Step 8: If your Medicare Advantage plan has different rules — call them first. Medicare Advantage (Part C) plans handle CGM coverage differently. Some have preferred CGM devices. Contact your plan's member services before ordering to avoid unexpected costs. Still need help? Find a CGM provider near you →