Medicare does provide coverage for blood sugar monitors, but the extent of that coverage depends heavily on the specific device type and whether the patient meets established medical necessity criteria. This coverage is managed through different parts of the overall program, requiring patients to understand which rules apply to which device. Obtaining a monitor and its ongoing supplies requires a prescription from a qualified healthcare provider and adherence to documentation requirements. The federal government has periodically updated these rules to expand access to more advanced monitoring technology.
Understanding Medicare’s Device Classifications
Medicare categorizes medical equipment based on its nature and expected lifespan. Continuous Glucose Monitors (CGMs) are classified as Durable Medical Equipment (DME) by the Centers for Medicare & Medicaid Services (CMS). DME applies to devices that withstand repeated use, serve a medical purpose, and are typically used in a patient’s home.
This DME classification places CGMs and their associated supplies under Medicare Part B, which covers outpatient medical services and equipment. Traditional blood glucose meters, which use test strips and lancets, are also covered under Part B.
The rules for testing supplies differ based on the patient’s treatment regimen. Those using insulin receive coverage for a greater quantity of traditional testing supplies, such as test strips and lancets, under Part B. Individuals managing diabetes without insulin receive coverage for a more limited quantity. Supplies like syringes and needles used for injectable insulin are covered under Medicare Part D, the prescription drug plan, rather than Part B.
Eligibility Requirements for Continuous Glucose Monitors (CGMs)
Obtaining CGM coverage requires meeting specific criteria demonstrating medical need. A patient must have a diagnosis of diabetes (Type 1 or Type 2). Eligibility expands to beneficiaries treated with insulin, regardless of the type or amount used.
Alternatively, a patient may qualify if they have a history of “problematic hypoglycemia” despite not using insulin. This condition is defined as recurrent Level 2 hypoglycemic events (glucose below 54 mg/dL), or a single Level 3 event requiring assistance due to an altered mental or physical state. The medical record must document these events to support the need for a CGM.
The treating practitioner must determine that the patient, or their caregiver, has sufficient training to use the device as prescribed. Before ordering the CGM, the practitioner must have conducted an in-person or Medicare-approved telehealth visit with the patient within the preceding six months. This visit is necessary to evaluate the patient’s diabetes control and to confirm that all coverage criteria are being met and documented in the medical record.
The CGM system must be approved by the Food and Drug Administration (FDA) for use in making treatment decisions. Medicare requires the system to utilize a stand-alone receiver or an insulin pump classified as DME to display the glucose data. While patients can use a compatible smartphone to view data, the dedicated DME receiver must be used at least some of the time for coverage to apply.
Navigating Coverage Costs and Essential Supplies
The financial structure for covered blood sugar monitors and supplies follows the standard rules for Durable Medical Equipment under Part B. After the annual Part B deductible is met, the patient is responsible for 20% of the Medicare-approved amount. Medicare pays the remaining 80% of the cost, assuming the supplier accepts assignment.
This 20% coinsurance applies to the CGM device itself, as well as the supplies required for ongoing use. These supplies include disposable sensors and the transmitters that send the glucose data. If the patient meets the eligibility criteria for the CGM, the sensors and transmitters are covered continuously.
For traditional blood glucose meters, the meter itself is covered, but the ongoing cost is primarily from the test strips and lancets. A patient using insulin typically qualifies for up to 300 test strips and 300 lancets every three months under Part B. Non-insulin users are covered for up to 100 test strips and lancets during the same three-month period. Cost-sharing for these supplies is the standard 20% coinsurance after the Part B deductible.