How to Get a CGM Through Medicare: A Step-by-Step Guide

Managing diabetes can feel overwhelming, but continuous glucose monitors (CGMs) can make it easier to stay on top of your blood sugar levels. If you’re a Medicare beneficiary, you may be wondering how to access this technology without the high out-of-pocket cost. The good news? Medicare CGM coverage is available if you meet certain qualifications. Here’s a clear, step-by-step guide on how to get a CGM through Medicare so you can take control of your health with confidence.

What Is a CGM?

A continuous glucose monitor (CGM) is a wearable device that tracks your blood glucose levels throughout the day and night, sending readings to a receiver or smartphone. Unlike fingerstick testing, CGMs provide real-time data and trends, helping you make informed decisions about your diet, exercise, and insulin use.

Does Medicare Cover CGMs?

Yes, Medicare does cover CGMs for qualifying beneficiaries under Medicare Part B as durable medical equipment (DME), provided specific criteria are met.

To qualify for Medicare CGM coverage, you typically must:

• Have diabetes (Type 1 or Type 2).
• Use insulin (multiple daily injections or a continuous subcutaneous insulin infusion pump).
• Require frequent blood glucose monitoring (four or more times per day).
• Have seen your doctor and received training on using the CGM device.

Medicare covers CGMs such as Dexcom G7 and Freestyle Libre 2 and 3 if you meet the eligibility criteria.

Step-by-Step Guide: How to Get a CGM Through Medicare

1. Check Your Eligibility
Before you can get a CGM through Medicare, confirm you:

• Are diagnosed with diabetes.
• Are on insulin therapy.
• Test blood glucose levels frequently.
• Have documentation from your doctor supporting medical necessity.

2. Schedule a Doctor’s Appointment
Your healthcare provider will assess your condition and document the need for a CGM in your medical records. They may require:

• A detailed log of blood glucose testing.
• Information on your insulin use.
• A discussion about how a CGM will improve your diabetes management.

3. Obtain a Prescription
Your doctor will write a prescription for a Medicare-approved CGM and related supplies. Ensure the prescription includes:

• The specific CGM device.
• Quantity and frequency of sensors and supplies.
• Confirmation that the CGM is medically necessary for diabetes management.

4. Work With a Medicare-Approved Supplier
CGMs covered under Medicare Part B must be obtained through a Medicare-enrolled DME supplier such as Finnegan Health. We can verify your Medicare coverage, collect the prescription, and handle paperwork.

5. Understand Costs Under Medicare
Under Medicare Part B, you are typically responsible for:

• 20% of the Medicare-approved amount (coinsurance) after meeting your Part B deductible.
• Medicare covers 80% of the CGM cost and supplies.

If you have a Medigap plan, it may cover your 20% coinsurance, reducing your out-of-pocket costs further.

6. Receive Training and Begin Using Your CGM
Once you receive your CGM, your doctor or diabetes educator can train you on:

• Sensor placement.
• Reading your CGM data.
• Integrating the CGM into your diabetes management plan.

Using your Medicare CGM consistently can help you identify patterns, avoid highs and lows, and improve your quality of life.

Tips to Maximize Your Medicare CGM Benefits

• Document blood glucose checks and insulin use to maintain eligibility.
• Schedule regular follow-ups with your provider to renew prescriptions.
• Learn to interpret CGM trends to adjust lifestyle and insulin dosing safely.
• Contact your supplier in advance for sensor refills to avoid gaps in monitoring.

Common Questions About Medicare CGMs

What CGMs are covered by Medicare?Medicare covers CGMs classified as therapeutic CGMs, including Dexcom G7, Freestyle Libre 2 and 3, and similar devices.

Can I get a CGM if I have Type 2 diabetes?
Yes, if you use insulin and meet Medicare’s criteria, you can qualify for a Medicare CGM even if you have Type 2 diabetes.

Do Medicare Advantage plans cover CGMs?
Yes, Medicare Advantage (Part C) plans cover CGMs, but coverage and supplier networks may vary by plan. Check with your plan for specifics.

Take Control of Your Diabetes with a Medicare CGM

Getting a CGM through Medicare can empower you to better manage your diabetes with less guesswork and greater peace of mind. By following the steps above and working closely with your healthcare provider, you can access this valuable technology and improve your long-term health.

Check out our diabetes products & specfifcally our CGM product at Finnegan Health for more information.