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Medicare CGM Supply Allowance: How Many Sensors Can You Get?
Last updated: January 2025 Understanding your Medicare CGM supply allowance doesn’t have to be complicated. As a Medicare beneficiary with diabetes, you’re entitled to a specific number of continuous glucose monitoring (CGM) sensors each month – but knowing exactly what you can get and how to get it is crucial for managing your diabetes effectively. This article provides general information about Medicare coverage for CGM supplies. Always verify specific coverage with Medicare or call us at 727-831-3729 for personalized assistance.What Is the Medicare CGM Supply Allowance?
Your Medicare CGM supply allowance covers the sensors, transmitters, and other supplies needed for continuous glucose monitoring. In 2025, Medicare provides coverage for these supplies under Part B when you meet specific eligibility criteria.Monthly CGM Supply Coverage:
- Up to 3 sensors per month for most CGM systems
- 1 transmitter every 3 months
- Batteries and other necessary supplies
How Many CGM Sensors Does Medicare Cover?
The exact number of sensors Medicare covers depends on your specific CGM system:- Dexcom G7: 3 sensors per month (10-day wear)
- FreeStyle Libre 3: 2 sensors per month (14-day wear)
- Guardian: 3 sensors per month (7-day wear)
Qualifying for Medicare CGM Coverage in 2025
To receive your Medicare CGM supply allowance, you must meet these requirements:- Have a diagnosis of Type 1 or Type 2 diabetes
- Complete CGM training (your prescription serves as evidence)
- Either use insulin or have documented problematic hypoglycemia
- Have had a diabetes-related visit within 6 months
- Continue follow-up visits every 6 months
Breaking Down Your Monthly Allowance
FreeStyle Libre Users
What you get:- 2 sensors per month
- Each sensor lasts 14 days
- 1 reader (if not using smartphone)
- Medicare-approved amount: ~$140 per sensor
- Medicare pays: $112 (80%)
- Your cost: $28 (20%) per sensor
- Monthly cost: $56 without supplemental coverage
Dexcom Users
What you get:- 3 sensors per month
- Each sensor lasts 10 days
- 1 transmitter every 3 months
- 1 receiver (if not using smartphone)
- Medicare-approved amount: ~$100 per sensor
- Medicare pays: $80 (80%)
- Your cost: $20 (20%) per sensor
- Monthly cost: $60 without supplemental coverage
Real-World Examples
Sarah’s Story
Sarah, 72, Type 2 diabetes: “I use FreeStyle Libre 3. Medicare gives me exactly 2 sensors each month, which covers all 28-30 days. With my Medigap Plan G, I pay nothing out of pocket.”Robert’s Experience
Robert, 68, Type 1 diabetes: “My Dexcom G7 requires 3 sensors monthly. I time my orders carefully to never run out. The 90-day transmitter replacement schedule works perfectly.”Managing Your Supply Schedule
Best Practices for Continuous Coverage
Order Early- Request refills when you have 7-10 days of supplies left
- Account for shipping time (3-5 business days)
- Keep one backup sensor if possible
- Mark calendar with sensor change dates
- Set reminders for reorder times
- Note transmitter replacement dates
- Don’t wait until supplies run out
- Communicate with your supplier regularly
- Update prescriptions before they expire
Common Supply Allowance Questions
“What if my sensor fails early?”
Medicare allows replacement for defective sensors:- Document the failure (photos help)
- Contact manufacturer immediately
- Request replacement through supplier
- Keep all documentation
“Can I get extra sensors for travel?”
Medicare typically maintains monthly limits, but:- Plan ahead for extended trips
- Order maximum allowed before leaving
- Consider travel timing with supply schedule
- Some suppliers offer vacation overrides
“What about transmitter replacements?”
Transmitter replacement schedule:- Dexcom: Every 3 months
- FreeStyle Libre 3: Built into sensor
- Guardian: Every 12 months
Medicare Advantage vs. Original Medicare
Supply Allowances Comparison
Original Medicare:- Consistent nationwide coverage
- 80/20 cost split
- Freedom to choose suppliers
- Same allowance everywhere
- May have different copay structures
- Preferred supplier requirements
- Some plans offer extra supplies
- Prior authorization may be required
Tips for Maximizing Your Allowance
1. Extend Sensor Life Safely
- Follow manufacturer guidelines exactly
- Protect sensors from damage
- Use appropriate adhesive products
- Avoid premature removal
2. Prevent Waste
- Store supplies properly
- Check expiration dates
- Rotate stock (first in, first out)
- Handle with care
3. Work with Your Supplier
- Establish automatic shipments
- Communicate changes promptly
- Keep contact information updated
- Build relationship with customer service
What’s NOT Covered in Your Allowance
Medicare CGM coverage excludes:- Over-the-counter adhesive patches
- Smartphone apps (they’re free)
- Decorative sensor covers
- Extra supplies beyond limits
Documentation Requirements
Keep These Records:
- Prescriptions (update annually)
- Medical necessity documentation
- Supply delivery receipts
- Communication with suppliers
- Sensor failure reports
Why Documentation Matters:
- Supports appeals if needed
- Helps with supplier issues
- Proves continuous use
- Validates Medicare requirements
Troubleshooting Supply Issues
Common Problems and Solutions
“My supplier says I’m not due for supplies”- Check last delivery date
- Verify days’ supply calculation
- Confirm prescription is current
- Request supervisor review
- Verify all requirements are met
- Check recent doctor visits
- Ensure documentation is complete
- File appeal if necessary
- Review proper sensor duration
- Check for early removals
- Document any failures
- Discuss with healthcare provider
Planning Your Supply Calendar
Monthly Checklist:
Week 1: Use first sensor/check supplies Week 2: Mid-month sensor change Week 3: Order new supplies Week 4: Receive and verify shipmentQuarterly Tasks:
- Update prescriptions if needed
- Review transmitter replacement schedule
- Verify insurance coverage
- Schedule doctor appointments
Cost-Saving Strategies
With Original Medicare:
- Consider Medigap for 20% coverage
- Use Medicare-approved suppliers only
- Take advantage of competitive bidding
- Ask about financial assistance
With Medicare Advantage:
- Use in-network suppliers
- Understand your plan’s structure
- Meet deductibles strategically
- Utilize plan extras
Special Circumstances
Hospital Stays
- Bring your own supplies
- Inform staff about CGM use
- Document any removed sensors
- Request replacement if needed
Skilled Nursing Facilities
- Coordinate with facility
- Maintain your own supplies
- Educate staff on CGM
- Continue regular orders
Travel Considerations
- Order maximum before trips
- Carry supplies in carry-on
- Bring prescription documentation
- Research suppliers at destination
Future Outlook
Potential Changes Coming:
- Expanded sensor allowances
- New CGM approvals
- Simplified prior authorization
- Enhanced coverage options
Your Action Steps
- Review your current allowance – Know your limits
- Check your prescription – Ensure it’s current
- Calculate your needs – Plan accordingly
- Set up reminders – Never run out
- Build supplier relationship – Communicate regularly
