Will Medicare pay for continuous glucose monitors?

Millions of Medicare recipients receive coverage for diabetes. If you are one of them, continuous glucose monitors (CGM) are a valuable resource in managing this disease. But does Medicare cover continuous glucose monitors (CGM)?

Fortunately, Medicare does cover several types of continuous glucose monitoring systems for diabetes management. Medicare Supplement plans may be your best tool for getting your CGM covered. Our free search tool is a great place to find the right supplemental insurance for you.

The good news is, we’ve done the research for you. Read on to discover if a CGM is right for you, and how you can get one as affordably as possible.

Find the Right Device for You

Before you determine if Medicare will cover your continuous glucose monitor, you need to find the right device. Currently, there are several options on the market for people with diabetes that provide continuous glucose monitoring.

Outside of Medtronic CGMs, nearly all continuous glucose monitoring devices are currently covered by Medicare. There are differences that determine the type of coverage, so let’s dive in.

The main feature that sets one CGM apart from another is its reliance on fingersticking. Therapeutic CGMs do not need fingerstick backup data, so they provide a much simpler and more user-friendly experience in terms of treatment decisions. Therapeutic CGM devices are generally covered by Medicare.

Perhaps the most popular therapeutic CGM system available comes from Dexcom. The advanced Dexcom system is currently covered by Medicare. However, Dexcom itself no longer distributes their own equipment, so even if you qualify, your doctor will have to place the order for you.

Dexcom provides state-of-the-art equipment to be sure, but it comes at a high price. Be certain your claim is accepted by Medicare before you place the order. You don’t want to get stuck with the bill if your insurance isn’t willing to reimburse you.

Once you’ve found the right model, talk with your doctor to determine if you meet Medicare’s guidelines for coverage.

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Medicare Guidelines for Coverage

CGMs work for patients with both major types of diabetes, so if you are a Medicare recipient with either condition, you can qualify for Medicare reimbursement for CGM.

To do so, you must meet several qualifications. You must be receiving three or more daily insulin treatments or using a continuous subcutaneous insulin infusion pump (CSII).

You must have seen your doctor within six months of placing the CGM order, with the purpose of evaluating the handling of your diabetes. Every six months after that, you have to be reevaluated by your doctor to ensure you are complying with your diabetes treatment plan.

Your receiving equipment must be classified as DME (durable medical equipment). Many mobile devices allow you to monitor your glucose levels, but you cannot rely solely on your smartphone to receive glucose monitoring. You must use Medicare approved durable medical equipment.

Finally, before Medicare will approve your claim, and before you can order your CGM, you will need a prescription from your doctor. For more information on how to obtain the right plan, and find the right doctor, read through our Medicare Guide here.

Does Medicare cover Medtronic CGM?

The simple answer is no.

At least not yet. There are currently measures before Congress to address this discrepancy, but as of now Medtronic CGM is not covered. Medtronic is reliant on fingerstick readings, and thus not considered a “therapeutic CGM”. 

If you and your doctor decide Medtronic is your best treatment option, you can pay out of pocket, or use supplemental insurance to cover the cost. There are several financing options available for Medtronic equipment, but you will be responsible for the majority of the expense.

If you and your doctor determine Medtronic CGM is right for you, it will pay to stay updated on this topic. According to Healthline.com if Congress approves Medtronic in the new budget, the costs for such devices could be reduced considerably. They may even be covered by Medicare soon, so pay attention.

Case Studies: Medicare Coverage for Continuous Glucose Monitors

Case Study 1: Successful Coverage with Therapeutic CGM

Mary, a Medicare recipient with type 2 diabetes, was using three daily insulin treatments. Her doctor recommended a therapeutic continuous glucose monitor (CGM) to help manage her condition.

Mary met all the Medicare guidelines for coverage, including regular doctor visits and the use of approved durable medical equipment. She submitted a claim and received full coverage for her CGM, significantly improving her glucose monitoring experience.

Case Study 2: Dexcom CGM Coverage

John, a Medicare recipient with type 1 diabetes, wanted to switch to a Dexcom CGM due to its advanced features. After consulting with his doctor, he confirmed that John met Medicare’s qualifications for coverage.

However, Dexcom equipment was no longer distributed directly by the company, so John’s doctor had to place the order for him. John’s claim was accepted by Medicare, and he obtained the Dexcom CGM with minimal out-of-pocket expenses.

Case Study 3: Medtronic CGM Coverage Challenges

Sarah, a Medicare recipient with type 1 diabetes, preferred the Medtronic CGM for her diabetes management. However, she discovered that Medtronic CGM was not currently covered by Medicare as it relied on fingerstick readings and was not classified as a therapeutic CGM.

Sarah had to explore alternative options such as paying out of pocket or seeking supplemental insurance to cover the cost of the Medtronic CGM.

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The Bottom Line on Medicare Coverage for CGMs

Advancements in CGM technology have made living with diabetes achievable. You can be happy and healthy and still treat your condition responsibly. If you qualify for a therapeutic CGM system, you no longer have to deal with pricking your fingers multiple times a day.

If you and your doctor determine that continuous glucose monitoring is right for you, there is a good chance you can get your equipment covered by Medicare. Follow the above guidelines, and you may find your quality of life improving, at little or no cost to you.

If you are not able to get Medicare coverage for your CGM, you have other resources as well. Your doctor can help you decide if paying out of pocket or using supplemental insurance is best for you.

And don’t forget to keep current on the budgetary proceedings in Congress. You may just find your CGM is covered by Medicare in the near future.

For the best rates on Medicare coverage for all your CGM needs, enter your ZIP code here.

 

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