Understanding Medicare CGM for Seniors coverage can feel overwhelming, but we’re here to help make it simple. This comprehensive guide breaks down everything Medicare beneficiaries need to know about continuous glucose monitor (CGM) coverage in 2025, including eligibility requirements, costs, and how to get started.
⚠️ Important 2028 Update: Medicare is making major changes to how CGMs are covered through competitive bidding. If you rely on a CGM, you need to know what’s coming.
Quick Summary of 2025 Medicare CGM Coverage
- Medicare Part B CGM Requirements: Do You Qualify in 2025?Medicare Part B covers therapeutic CGMs that are FDA-approved
- You pay 20% of the Medicare-approved amount after meeting your Part B deductible
- Most Medicare Advantage plans also cover CGMs
- Medicare Part D and Diabetes Supplies
- You must meet specific eligibility criteria and have documentation from your doctor
Who Qualifies for CGM Coverage Under Medicare?
To qualify for Medicare CGM coverage in 2025, you must meet these requirements:
- Have diabetes (Type 1 or Type 2)
- Test blood sugar 4+ times daily
- Take insulin multiple times per day OR use an insulin pump
- Require frequent insulin dosage adjustments
- Have a face-to-face visit with your healthcare provider in the last 6 months
Which CGM Systems Does Medicare Cover?
Medicare covers FDA-approved therapeutic CGMs, including:
- Dexcom G7
- Dexcom G6
- FreeStyle Libre 2
- FreeStyle Libre 3
Note: Coverage may vary by specific model and your individual circumstances. Check out our FreeStyle Libre vs Dexcom for Medicare Coverage Guide. Contact your Medicare plan directly to verify coverage for your preferred device.
If you would like to understand what Medicare Codes are for CGM read our Quick Reference
Understanding Your Costs
Medicare Part B Coverage
- You pay 20% of the Medicare-approved amount
- Must meet annual Part B deductible ($240 in 2025)
- Typical monthly out-of-pocket costs: $40-60
Medicare Advantage Plans
Medicare Advantage (Part C) plans must provide at least the same coverage as Original Medicare, but costs may vary. Many plans offer additional benefits or lower copayments.
How to Get Started with Medicare CGM Coverage
- Consult Your Doctor
- Schedule a face-to-face visit
- Discuss your diabetes management needs
- Get documentation of medical necessity
- Choose a CGM System
- Research Medicare-covered options
- Consider features and ease of use
- Discuss preferences with your healthcare team
- Verify Coverage
- Contact Medicare directly
- Check with your Medicare Advantage plan if applicable
- Confirm coverage details with supplier
- Need help understanding your explanation of benefits (EOB) Read more here.
Required Documentation
Your healthcare provider must submit:
- Detailed prescription for CGM system
- Recent medical records showing diabetes diagnosis
- Documentation of blood sugar testing frequency
- Proof of insulin use and adjustment needs
- Records from face-to-face visit within 6 months
Common Coverage Challenges and Solutions
Challenge 1: Denial of Coverage
If Medicare denies coverage:
- Review denial reason carefully
- Ensure all documentation is complete
- Appeal if you believe the denial is incorrect
- Work with your doctor to provide additional documentation
Challenge 2: Supply Reorders
To maintain coverage for supplies:
- Order only when supplies are nearly depleted
- Keep detailed records of usage
- Maintain regular doctor visits
- Update prescriptions as needed
Tips for Successful CGM Coverage
- Keep detailed records of all diabetes-related medical visits
- Maintain regular contact with your healthcare team
- Document blood sugar testing frequency
- Save copies of all Medicare correspondence
- Set reminders for supply reorders and prescription renewals
2025 Updates and Changes
Key Medicare CGM coverage updates for 2025 include:
- Expanded coverage for certain CGM models
- Updated documentation requirements
- Simplified approval process for some beneficiaries
- New digital health integration options
Additional Resources and Support
Take advantage of these helpful resources:
- Medicare Coverage Checker Tool on our website
- Free Medicare CGM Guide (downloadable PDF)
- One-on-one consultation with our Medicare specialists
- How to get CGM through Medicare Step by Step Guide
- Educational webinars and training sessions
- State Assistance Programs for Diabetic Seniors
- State by State Coverage Guide
- COBRA Coverage for CGM
- Charitable programs for free diabetic supplies
- California Medicare Guide
- Florida Medicare Guide
- Georgia Medicare Guide
- Illinois Medicare Guide
- Michigan Medicare Guide
- New York Medicare Guide
- North Carolina Guide
- Ohio Medicare Guide
- Pennsylvania Medicare Guide
- Texas Medicare Guide
- Low Income Subsidies for CGM
- Veterans Benefits for Diabetes Supplies
- Veterans VA Benefits vs. Medicare
Conclusion
Medicare CGM coverage in 2025 provides valuable access to continuous glucose monitoring technology for eligible seniors. While the process may seem complex, understanding your benefits and following the proper steps can help ensure successful coverage.
Need help navigating your Medicare CGM coverage?
- 📱 Call us at 727-831-3729
- 💻 Use our Medicare Coverage Checker Tool
- 📄 Download our Free Medicare CGM Guide
Medical Disclaimer: This content is for educational purposes only and should not replace professional medical advice. Always consult with your healthcare provider before making changes to your diabetes management plan.
Your Rights as a Medicare Beneficiary
As a Medicare beneficiary with diabetes, you have important rights regarding CGM coverage:
- Right to choose your supplier – You can select any Medicare-approved DME supplier
- Right to quality products – You’re entitled to FDA-approved CGM systems
- Right to timely delivery – Supplies should arrive before you run out
- Right to clear billing – You deserve transparent billing statements
- Right to appeal denials – If denied, you can fight the decision
Medicare Appeals Process: Fighting a Denial
If Medicare denies your CGM coverage, don’t give up. Here’s the appeals process:
Level 1: Redetermination
- File within 120 days of denial
- Include any new medical documentation
- Get a support letter from your doctor
- Decision within 60 days
Level 2: Reconsideration (QIC Review)
- Independent review by Qualified Independent Contractor
- File within 180 days of Level 1 decision
- Focus on medical necessity
- Decision within 60 days
Higher Appeal Levels
- Level 3: Administrative Law Judge hearing
- Level 4: Medicare Appeals Council review
- Level 5: Federal District Court
Free Help Available: Contact your local State Health Insurance Assistance Program (SHIP) at 1-877-839-2675 for free Medicare counseling and appeals help.
What to Tell Your Doctor
When discussing CGM with your doctor, try these conversation starters:
- “I’d like to discuss getting a CGM through Medicare”
- “I’m having difficulty with frequent finger stick testing”
- “I’ve had episodes where my blood sugar dropped below 54” (if applicable)
- “I’d like better insight into my blood sugar patterns between meals and overnight”
- “Can you help document why CGM would be medically necessary for me?”
Frequently Asked Questions
Do I need to use insulin to qualify?
No! As of 2025, Medicare covers CGM for people with diabetes who either use insulin OR have documented problematic hypoglycemia (multiple episodes below 54 mg/dL).
How long does the approval process take?
Typically 1-2 weeks after your supplier receives all documentation. Initial review takes 3-5 business days, approval notification within 1 week, and first shipment 7-10 days after approval.
Can I travel with my CGM?
Yes! CGMs are TSA-approved. Request a travel letter from your doctor and bring extra supplies. Most CGMs work internationally, though Medicare coverage applies only for domestic travel.
What if I have both Medicare and Medicaid?
Dual eligibles often have no out-of-pocket costs. Medicaid typically covers the 20% that Medicare doesn’t pay.
Success Stories from Real Seniors
Maria, 72, Type 2 Diabetes: “I don’t use insulin but qualified due to overnight lows. My CGM caught patterns I never knew existed. Medicare covered it all with my supplement plan.”
James, 75, Non-Insulin User: “I didn’t think I’d qualify since I don’t use insulin, but my history of low blood sugars was enough. The CGM has been life-changing.”
Robert, 68, Type 1 Diabetes: “The application process was easier than expected. My supplier handled everything, and I had my CGM within two weeks.”
