Yes, Medicare covers Dexcom continuous glucose monitors (CGMs) and their related supplies for people with diabetes, but you need to meet specific eligibility requirements. Coverage falls under Medicare Part B as durable medical equipment (DME), which means you’ll typically pay 20% of the Medicare-approved amount after meeting your annual Part B deductible.
Who Qualifies for Coverage
Medicare will cover a Dexcom CGM if you meet two conditions. First, you must either take insulin or have a documented history of problematic low blood sugar (hypoglycemia). Second, your doctor must confirm that you or your caregiver have been adequately trained to use the device as prescribed.
This means coverage isn’t limited to people with Type 1 diabetes. If you have Type 2 diabetes and use insulin, you qualify. If you have Type 2 and experience hypoglycemia episodes even without insulin use, you may also be eligible. However, if you manage your diabetes exclusively with oral medications and have no history of low blood sugar, Medicare is unlikely to approve coverage.
One important technical requirement to be aware of: Medicare classifies CGMs as durable medical equipment, which means the device must be able to display readings on a standalone receiver or integrate with an insulin pump. A CGM that only works through a smartphone app, with no standalone receiver option, does not meet Medicare’s definition of DME and will be denied. Dexcom systems do offer receiver options, so this generally isn’t a barrier, but it’s worth confirming your setup includes one.
What Your Doctor Needs to Do
Getting approved requires more than just a prescription. Within six months before ordering the CGM, your treating provider must have an in-person visit or Medicare-approved telehealth appointment with you to evaluate your diabetes control and confirm you meet the eligibility criteria. This visit needs to be documented in your medical record.
Once you’re approved, the paperwork doesn’t stop. Every six months, your doctor must see you again (in person or via telehealth) and document that you’re still using the CGM consistently, following your diabetes treatment plan, and that the device remains medically necessary. If these follow-up visits don’t happen, your continued coverage can be interrupted.
How Billing Works
Dexcom sensors, transmitters, and receivers are billed through Medicare Part B as DME, not through a pharmacy benefit. This distinction matters because it affects where you get your supplies and what you pay.
With Original Medicare (Part A and Part B), you’ll order supplies through a DME supplier rather than picking them up at a pharmacy. After you meet your Part B deductible ($257 in 2025), Medicare covers 80% of the approved amount and you pay the remaining 20%. If you have a Medigap (supplemental) policy, it may cover some or all of that 20% coinsurance.
Your doctor’s office will use specific billing modifiers depending on your treatment. If you use insulin, the claim is submitted with one modifier code. If you don’t use insulin but qualify based on hypoglycemia history, a different modifier is used. You won’t need to worry about this directly, but it’s worth knowing because incorrect coding is a common reason claims get denied. If you receive a denial, ask your provider’s billing department to verify the modifier was correct.
Medicare Advantage Plans
If you have a Medicare Advantage plan (Part C), you still have Part B coverage, so CGMs are included in your benefits. However, the specifics can vary quite a bit from plan to plan. Your copay amount, preferred DME suppliers, and prior authorization requirements may all differ from Original Medicare. Some Medicare Advantage plans may also offer CGM coverage through their Part D pharmacy benefit, which could change where you fill your supplies and what you pay out of pocket. Contact your plan directly to find out the details of your specific coverage.
Getting and Replacing Supplies
Medicare covers the CGM receiver (or a compatible device), sensors, and transmitters. Sensors need regular replacement since they’re designed to last a set number of days before a new one is applied. Your DME supplier will ship replacements on a schedule that aligns with Medicare’s approved refill timelines.
To keep supplies flowing without interruption, make sure you’re scheduling those required six-month follow-up visits with your doctor. A lapse in documentation is one of the most common reasons people experience gaps in their CGM supply shipments. Setting a recurring reminder for these appointments can save you a frustrating disruption.
If You’re Denied Coverage
Denials happen, and they’re not always final. The most common reasons include missing documentation from the initial evaluation visit, incorrect billing codes, or a medical record that doesn’t clearly establish insulin use or hypoglycemia history. If your claim is denied, ask your doctor’s office to review the documentation and resubmit. You also have the right to file a formal appeal with Medicare, and many denials are overturned when the correct paperwork is provided.