This article provides general information about CGM coverage, including how Medicare may cover CGM without insulin. It is not medical advice. Always consult your healthcare provider about your specific medical needs.
Wondering if you can get a CGM (Continuous Glucose Monitor) through Medicare without using insulin? The good news is that Medicare coverage for CGM without insulin use is possible in certain situations. Let’s walk through exactly what you need to know to qualify.
Understanding CGM Coverage Without Insulin
Medicare has recently expanded its coverage for CGM devices, recognizing that blood sugar monitoring is important for all diabetes patients, not just those using insulin. However, specific requirements must be met.
To qualify for CGM without insulin Medicare coverage, you must:
- Have a diagnosis of diabetes
- Test blood sugar at least 4 times daily
- Visit your doctor regularly for diabetes management
- Document that frequent testing is necessary for your treatment plan
Medicare Requirements for Non-Insulin CGM Coverage
Your doctor will need to show Medicare that you meet certain criteria:
- You have Type 1 or Type 2 diabetes
- You’re following a comprehensive diabetes treatment plan
- Your diabetes requires frequent adjustments to your treatment plan
- You’ve been testing multiple times daily for at least two months
💡 Keep a detailed log of your daily blood sugar readings. This documentation helps support your need for CGM coverage.
Steps to Get Started with CGM Without Insulin
- Schedule an appointment with your doctor specifically to discuss CGM
- Bring your blood sugar testing logs to show frequency of testing
- Ask your doctor to document why CGM would benefit your care
- Request a Medicare coverage determination letter
Common Questions About CGM Without Insulin Medicare Coverage
Which CGM Devices Are Covered?
Medicare typically covers these CGM systems for qualified patients:
- Dexcom G6
- FreeStyle Libre 2
- FreeStyle Libre 3
As of 2024, Medicare covers both therapeutic and non-therapeutic CGM devices when medical necessity is documented.
What Costs Should I Expect?
With Medicare coverage:
- 20% coinsurance after meeting Part B deductible
- Sensors typically covered every 30 days
- Transmitter replacement covered every 90 days
Tips for Success with Your CGM
New to CGM? Ask a family member to help you:
- Download the CGM app to your smartphone
- Set up alerts and notifications
- Practice inserting sensors
- Learn how to share readings with your doctor
Getting Help with Your CGM
Need assistance? We’re here to help:
- Call our support team: 888-649-5705
- Watch our video tutorials on our website
- Join our monthly virtual training sessions
- Request our large-print quick start guide
Remember: Using a CGM can help you better manage your diabetes, even without insulin use. Don’t hesitate to explore this option with your healthcare team.