Is a continuous glucose monitor covered?

The short answer

Often, yes. Medicare covers a therapeutic continuous glucose monitor for people with diabetes who meet its criteria — broadly, people who use insulin, and some people with a documented history of problematic low blood sugar — with a prescriber's order and a visit that documents the need.

The criteria have loosened several times in recent years, and they are plan-specific. If you were told no in the past, the answer may have changed since. We check the current rule against your situation rather than quoting one that may be out of date.

Wrinkles worth knowing about

• Some plans run CGM through the pharmacy benefit rather than the medical one. That changes where you get the sensors and what your share looks like — we tell you which applies to you before anything is ordered.
• Over-the-counter sensors now exist. You can buy some without insurance at all. If you qualify under your plan, the covered route with scheduled resupply is usually the better long-term arrangement — and we handle the paperwork either way.
• Sensors and transmitters run out on their own schedules. A CGM is a resupply commitment, not a one-time purchase; the coverage continues as long as the documentation stays current.

What we do about it

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