Medicare Advantage CGM Coverage vs Original Medicare: Which is Better?

Choosing between Medicare Advantage and Original Medicare for CGM (Continuous Glucose Monitor) coverage can feel overwhelming. As diabetes management experts focused on helping seniors, we’ll break down medicare advantage cgm coverage compared to Original Medicare to help you make the best choice for your health and budget.

Quick Summary: Medicare Advantage vs Original Medicare CGM Coverage

Understanding Medicare Advantage CGM Coverage

Medicare Advantage plans are required by law to cover CGMs at least as well as Original Medicare. However, the costs and approval process may differ:

• Some plans have lower copayments than Original Medicare’s 20%
• Prior authorization may be required
• In-network providers may be mandatory
• Additional diabetes management benefits might be included

Original Medicare CGM Coverage Details

Under Original Medicare Part B, CGM coverage includes:

• The CGM device itself (HCPCS code E2103)
• Monthly supplies like sensors (HCPCS code A4239)
• 80% coverage after meeting your deductible
• Freedom to choose any Medicare-accepting provider

Key Differences That Matter for Seniors

Here’s how Medicare Advantage CGM coverage compares to Original Medicare in practical terms:

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