Medicare Coverage for CGM Devices: What Seniors Need to Know in 2024

Medicare Part B Covers CGM Devices

Great news for Medicare beneficiaries: Medicare Part B covers continuous glucose monitors (CGMs) as durable medical equipment when you meet specific criteria. This coverage can save you thousands of dollars annually on diabetes management supplies.

Eligibility Requirements for Medicare CGM Coverage

To qualify for Medicare CGM coverage, you must meet these criteria:

Medical Requirements:

• Diabetes diagnosis: Type 1 or Type 2 diabetes
• Insulin therapy: Currently using insulin (multiple daily injections or pump)
• Frequent testing: Testing blood glucose 4 or more times per day
• Doctor's prescription: Written order from your healthcare provider

Medicare Requirements:

• Enrolled in Medicare Part B
• Meet Medicare's definition of medical necessity
• Use a Medicare-approved CGM supplier

What Medicare Covers

Medicare Part B covers several components of CGM therapy:

Covered Items:

• CGM Device: The receiver or compatible smartphone app
• Sensors: Replacement sensors (typically every 10-14 days)
• Transmitters: When medically necessary
• Training: Initial setup and education
• Supplies: Adhesive patches and insertion tools

Cost Breakdown

Understanding your out-of-pocket costs:

How to Get Your CGM Through Medicare

The process is straightforward when you work with experienced Medicare specialists:

1. Verify Coverage: Confirm your Medicare Part B benefits
2. Doctor Consultation: Get a prescription from your healthcare provider
3. Choose Supplier: Select a Medicare-approved CGM supplier
4. Submit Documentation: Provide medical records and prescription
5. Receive Device: Get your CGM delivered to your home

Common Medicare CGM Questions

Q: Do I need prior authorization?

A: No, Medicare does not require prior authorization for CGMs when you meet the eligibility criteria.

Q: Can I get a CGM if I'm not on insulin?

A: Currently, Medicare requires insulin therapy for CGM coverage. However, coverage rules may change, so it's worth checking your specific situation.

Q: How often can I get new sensors?

A: Medicare covers sensors based on the manufacturer's recommended replacement schedule, typically every 10-14 days.

Don't Wait - Act Now

Medicare CGM coverage can significantly improve your diabetes management while reducing your out-of-pocket costs. The sooner you start, the sooner you'll experience the benefits of continuous glucose monitoring.