Jack's Blog on Medicare Plan Choices

Medicare, Diabetes, and Continuous Glucose Monitors (CGM)

Managing diabetes can be complex, but Medicare offers coverage to help with many of the costs—especially for insulin and monitoring supplies. Here’s a simple overview of what’s covered and how it works.

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What Medicare Part D Covers:

• Insulin (injected via syringe or pen)
• Injection supplies like syringes, needles, alcohol swabs, and pens
• Oral diabetes medications

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What Medicare Part B Covers:

• Insulin used with a pump
• Insulin pumps, if medically necessary (as durable medical equipment)
• Continuous Glucose Monitors (CGMs) – for those who qualify
• Testing supplies like glucose meters, test strips, lancets, and control solution

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Continuous Glucose Monitors (CGMs) for Non-Insulin Users

CGM’s are devices that allow users to manage their diabetes without routine fingersticks and are accurate enough for real-time treatment decisions.

Many people believe CGMs are only for those who take insulin—but that’s not always the case. Medicare may cover CGMs for non-insulin users if certain medical requirements are met. Here’s what you need to know:

1. Medical Necessity Must Be Documented

To qualify, your doctor must determine and document that a CGM is medically necessary. This may include:

• Frequent episodes of hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar)
• Inconsistent blood sugar readings
• Difficulty using traditional fingerstick meters
• A medical need for more continuous or detailed glucose tracking

Your doctor’s records and notes must clearly explain why the CGM is needed as part of your diabetes management plan.

2. The CGM Must Be “Therapeutic” and FDA-Approved

Only certain CGMs are approved by Medicare for coverage. These devices must be:

• FDA-approved for making treatment decisions (not just for supplemental monitoring)
• Common examples include the Dexcom G7 and FreeStyle Libre 2 or 3

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What to Know About Costs:

Under Original Medicare, you typically pay 20% of the cost after meeting the Part B deductible.

If you have a Medigap plan, it may help cover those out-of-pocket expenses. Medicare Advantage