Medicare generally covers a new CGM (continuous glucose monitor) receiver once every five years. That’s the “reasonable useful lifetime” Medicare assigns to durable medical equipment, and it applies to CGM receivers as well. If your receiver breaks, is lost, or is stolen before that five-year mark, Medicare may cover a replacement sooner, but only under specific circumstances.
The Five-Year Replacement Rule
Medicare classifies CGM receivers as durable medical equipment (DME) under Part B. Like wheelchairs, CPAP machines, and other devices in that category, CGM receivers carry a reasonable useful lifetime of five years from the date you first start using the device. Once that period has passed, you’re eligible for a new one.
This timeline applies to the receiver (the handheld display unit) specifically, not to sensors or transmitters, which are consumable supplies covered on a recurring basis. Sensors are typically covered in monthly or quarterly shipments, and transmitters are replaced every few months depending on the system you use.
Getting a Replacement Before Five Years
If your receiver stops working, gets lost, or is stolen before the five-year window is up, Medicare can cover a replacement. You’ll need documentation to support the claim. For a malfunction, your DME supplier may ask for proof that the device is no longer functional. For loss or theft, you may need to provide a statement explaining what happened.
Medicare also makes exceptions after federally declared disasters or emergencies. If your equipment was damaged or destroyed in a qualifying event, Medicare will typically cover replacement costs without waiting for the five-year mark.
What Medicare won’t do is pay for an upgrade simply because a newer model is available. If your current receiver is working and still within its useful lifetime, you’d need to cover the cost of a newer device yourself or wait until you’re eligible for a replacement.
Smartphone Apps and Whether You Still Need a Receiver
Many newer CGM systems, including current Dexcom and FreeStyle Libre models, can send glucose data directly to a smartphone app. This raises a reasonable question: do you actually need to buy a receiver at all?
Medicare’s policy has evolved on this. The agency now allows beneficiaries to use smartphone apps to view their CGM data, including data-sharing features. However, when you first set up a new CGM system through Medicare, the standard supply bundle has historically included a receiver along with sensors and transmitters. Even if you plan to use your phone as your primary display, the receiver may still be part of the initial package your supplier provides and bills to Medicare.
If you already own a functioning receiver and only need ongoing sensors and transmitters, talk to your DME supplier about what’s actually being billed. You shouldn’t need to receive (or pay a copay on) a new receiver every time you reorder supplies.
Who Qualifies for Medicare CGM Coverage
Before the replacement schedule matters, you need to meet Medicare’s eligibility criteria for CGM coverage in the first place. Medicare covers a continuous glucose monitor if you have diabetes and meet two conditions: you either take insulin or have a history of problematic low blood sugar (hypoglycemia), and you or your caregiver have completed training on how to use the device properly.
Your prescribing provider needs to document these criteria in your medical record. Specifically, Medicare requires evidence that you have a diabetes diagnosis, that you’ve been trained on the device (supported by a prescription), that the CGM is prescribed in line with its FDA-approved use, and that it’s being used to improve blood sugar control. This documentation is established at your initial in-person or telehealth visit and stays in your record for future orders, including receiver replacements.
What You’ll Pay Out of Pocket
Under Original Medicare (Part B), CGM equipment follows standard DME cost-sharing rules. After you’ve met your annual Part B deductible, you typically pay 20% of the Medicare-approved amount for the receiver. Medicare covers the remaining 80%. If you have a Medigap (supplemental) policy, it may pick up some or all of that 20%.
If you’re enrolled in a Medicare Advantage plan (Part C), your coverage must be at least as comprehensive as Original Medicare, but your cost-sharing structure could look different. Copays, coinsurance percentages, and network requirements vary by plan. Some Medicare Advantage plans contract with specific DME suppliers, which can affect which CGM brands and receiver models are available to you and what you pay for them. Check with your plan directly for the details.
How to Start the Replacement Process
When your receiver is approaching five years old, or if it malfunctions sooner, contact your DME supplier to initiate a replacement. They’ll verify your eligibility, confirm the timing against Medicare’s records, and handle the billing. Your doctor may need to provide an updated prescription, particularly if your original order is several years old or if you’re switching to a different CGM system.
Keep a record of when you first received your current receiver. The five-year clock starts on the date you began using the device, not the date it was ordered or shipped. Having that date handy can speed up the process when it’s time for a new one.