Does Insurance Cover Continuous Glucose Monitors?

If you plan to buy a continuous glucose monitor or CGM system, you’re probably asking, “Does insurance cover CGMs and other diabetic supplies?” Read on to learn all about CGMs and insurance.

It’s not difficult to understand the appeal of continuous glucose monitoring (CGM) systems for people living with type 1 and 2 diabetes. As anyone who’s experienced a finger stick test knows, this process can be more than a little uncomfortable. CGMs can’t eliminate finger stick tests from your life, but they can help you to bypass this testing method most of the time.

However, these systems also represent yet another expense tied to diabetes management, so it’s easy to see why people with diabetes want to save as much as possible when buying them. If you’re wondering, “Does insurance cover diabetic supplies—specifically, CGMs?,” you’re in the right place. We have the answer to that question and everything else you need to know about CGM systems and insurance.

Will My Insurance Cover My CGM System?

If you have commercial health insurance, it’s good to know whether or not your insurance covers CGM systems before buying one of these products. While insurance coverage for continuous glucose monitoring systems can vary between different providers, most commercial insurers will cover products like these for people living with diabetes.

According to major CGM manufacturer Dexcom, the Dexcom G7 CGM System is covered under Medicare. Along with that, most people with type 1 diabetes who have commercial health insurance can get coverage for CGM systems.* Meanwhile, Abbott—one of Dexcom’s primary competitors and the company behind the FreeStyle Libre CGM brand—has stated that its products are widely covered by private insurers and Medicare.^†,‡

Are CGMs Covered by Medicare?

Of course, not every person with diabetes has private health insurance; instead, you might have Medicare. Since coverage can vary between private and federal health insurance, it’s wise to know whether or not Medicare will cover your CGM system.

As Dexcom and Abbott have indicated, Medicare will typically cover continuous glucose monitoring systems and related supplies. However, you’ll need to meet a few requirements first. To qualify for CGM coverage under Medicare, patients must:

1. Have a type 1 or type 2 diabetes diagnosis
2. Have received proper training for CGM usage, as indicated by a prescription
3. Plan to use their CGM in keeping with FDA indications
4. Use insulin and/or have a history of problematic hypoglycemia (including multiple level 2 hypoglycemic events and at least one level 3 hypoglycemic event)
5. Have completed an in-person or telehealth visit with their healthcare provider within six months of ordering their CGM to ensure they meet the criteria listed above

To maintain their Medicare insurance coverage for continuous glucose monitoring systems and supplies, people living with diabetes have to meet with their healthcare provider every six months after receiving their prescription. This ensures healthcare providers can confirm that their patients are sticking to their CGM regimen.

How Much Does A Continuous Glucose Monitor Cost Monthly?

As you might expect, the monthly cost of a CGM system can vary from one patient to the next based on insurance coverage and other factors. To give you a better idea of the situation, let’s look at the monthly cost of CGMs from two of the leading companies in this industry—Abbott and Dexcom.

Dexcom vs FreeStyle Libre Cost

According to Dexcom, commercial insurance plans are adding the Dexcom G7 CGM System on a weekly basis. For people with insurance plans that do not cover this product, Dexcom offers a special rate of $89/month through certain suppliers.

Meanwhile, Abbott has stated that people with commercial insurance typically pay a maximum of $65 for a FreeStyle Libre 2 reader and $75/month for sensors at participating pharmacies.^¶,§. The amount you’ll actually pay could differ from that based on how much your insurance covers.

Your Source for CGM Systems

So, does insurance cover diabetic supplies such as CGMs? This can be a tricky question to answer. Chances are yes, your insurance will likely cover your CGM system if you have private insurance or Medicare. Finding a trustworthy company for these products isn’t enough—you’ll also need to find a supplier that accepts your insurance.

At ADS, we don’t just offer a broad selection of CGMs (including the Dexcom G7 CGM System and the FreeStyle Libre 3 system). We also serve Medicare, many different commercial health plans, and other forms of insurance. Along with that, we’re proud to sell diabetes supplies such as insulin, traditional glucose meters, and diabetes testing supplies. Order the products you need today!

Resources

*Dexcom data on file (commercial insurance plans for T1 and T2 patients taking insulin)

^†Patients must meet Medicare eligibility coverage criteria.

^‡Local Coverage Determination (LCD) L33822, Glucose Monitors, https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33822.

^¶Benefits for FreeStyle Libre 2 sensors apply to two FreeStyle Libre 2 sensors per month. Benefits for FreeStyle Libre 2 reader apply to one FreeStyle Libre 2 reader. Void where prohibited by law. Abbott may modify, rescind, or revoke these benefits at any time without notice. Offer available to commercially insured patients only. These benefits are not available to beneficiaries of Medicare, Medicaid or other federal or state healthcare programs. For Massachusetts residents, only those patients responsible for the full cost of the product may be eligible to receive these benefits. These benefits are only available at participating pharmacies, which are subject to change without notice. The actual amount a patient pays may vary. The FreeStyle Libre 2 system requires a prescription.

^§Data on File. Abbott Diabetes Care.

Written by ADS Staff

Reviewed by Halle Elbling, MS, RDN, CDCES