Medicare Advantage Plans: Which Ones Cover CGM Best?
Finding the right Medicare Advantage plan that covers continuous glucose monitors (CGMs) can feel overwhelming. We’ll help you understand medicare advantage plans cgm coverage and identify which plans offer the best benefits for managing your diabetes.
Key Points:
- Most Medicare Advantage plans cover CGMs when you meet Medicare’s coverage criteria
- Coverage and costs vary by plan and insurance provider
- Some plans offer additional diabetes management benefits
Understanding Medicare Advantage CGM Coverage in 2025
Medicare Advantage plans (Medicare Part C) must provide at least the same coverage as Original Medicare. This means if you qualify for CGM coverage under Medicare’s guidelines, your Medicare Advantage plan will cover it too.
2025 Medicare CGM Coverage Requirements:
- Diagnosed with Type 1 or Type 2 diabetes
- Using insulin OR have documented problematic hypoglycemia
- Completed CGM training
- Regular doctor visits every 6 months
Top Medicare Advantage Plans for CGM Coverage
While all Medicare Advantage plans must cover CGMs, some offer better benefits than others. Here are the features to look for:
- Lower copayments for CGM supplies
- Reduced or waived deductibles for diabetes management
- Additional diabetes care benefits
- Large network of endocrinologists and diabetes educators
Pro Tip: Call our Medicare specialists at 727-831-3729 to compare CGM coverage across different plans in your area.
2025’s Best Medicare Advantage Plans for CGM Users
1. UnitedHealthcare (AARP Medicare Advantage)
CGM Coverage Details:
- Monthly CGM supply copay: $35-$47
- No prior authorization for preferred CGMs
- $0 deductible on many plans
- Extensive DME supplier network
Additional Benefits:
- Renew Active gym membership
- $0 copay for diabetes self-management training
- Over-the-counter benefit ($40-$100 quarterly)
- 24/7 nurse hotline
Best For: Seniors who value large networks and extra wellness benefits
2. Humana Medicare Advantage
CGM Coverage Details:
- Monthly CGM supply copay: $30-$40
- Quick prior authorization (48-72 hours)
- Preferred supplier discounts available
- Mail-order option for convenience
Additional Benefits:
- Go365 rewards program
- $0 preventive dental
- SilverSneakers fitness program
- Healthy food card ($50-$75 monthly)
Best For: Active seniors wanting rewards for healthy behaviors
3. Kaiser Permanente (Available in Select States)
CGM Coverage Details:
- Monthly CGM supply copay: $20-$30
- Integrated care model
- Same-day CGM training available
- In-house endocrinology team
Additional Benefits:
- Comprehensive diabetes program
- Nutrition counseling included
- Mental health support
- Coordinated care teams
Best For: Seniors preferring all-in-one healthcare systems
4. Anthem Blue Cross Blue Shield
CGM Coverage Details:
- Monthly CGM supply copay: $40-$50
- National network coverage
- Travel benefits included
- Multiple CGM brand options
Additional Benefits:
- LiveHealth Online telehealth
- SilverSneakers or gym reimbursement
- Preventive care rewards
- Meal delivery benefit (select plans)
Best For: Seniors who travel frequently
5. Aetna Medicare Advantage
CGM Coverage Details:
- Monthly CGM supply copay: $35-$45
- Resources for Living support
- CVS Health integration
- 90-day mail-order savings
Additional Benefits:
- $0 generic medications (select plans)
- Dental, vision, hearing coverage
- Fitness benefit options
- 24/7 telemedicine
Best For: Seniors using CVS pharmacies regularly
Regional Champions Worth Considering
Florida: Florida Blue Medicare
- CGM copay: $25-$35
- Strong Florida provider network
- Hurricane supply provisions
California: SCAN Health Plan
- CGM copay: $20-$30
- Excellent customer service ratings
- Transportation benefits included
Texas: WellCare by Centene
- CGM copay: $30-$40
- Expanded rural coverage
- Flex card benefits
How to Compare Plans in Your Area
Step 1: Check Availability
Not all plans operate in every ZIP code. Use Medicare.gov Plan Finder or call 727-831-3729 for personalized help.
Step 2: Compare Key Factors
Monthly Premium
- Ranges from $0 to $200+
- Higher premiums often mean lower copays
CGM Copayments
- Monthly supplies: $0-$50
- Initial device: May be higher
Annual Out-of-Pocket Maximum
- Ranges from $3,000 to $8,300
- Protects against catastrophic costs
Network Size
- Check if your doctors participate
- Verify DME suppliers in network
Step 3: Consider Total Value
Calculate annual costs including:
- Monthly premiums × 12
- CGM copays × 12
- Other diabetes medications
- Doctor visit copays
Special Considerations for CGM Users
Prior Authorization Tips
- Some plans approve faster than others
- Keep documentation ready
- Work with experienced DME suppliers
Preferred CGM Brands
- Most plans cover FreeStyle Libre and Dexcom
- Some have preferred brands with lower copays
- Check formulary before enrolling
Travel Coverage
- Original Medicare works nationwide
- Medicare Advantage may have restrictions
- Consider if you’re a snowbird
Real Senior Experiences
Maria, 72, chose UnitedHealthcare: “The $47 monthly copay seemed high, but with their gym membership and OTC benefit, I actually save money overall.”
George, 68, picked Kaiser: “Having everything under one roof is worth it. My endocrinologist and primary doctor actually talk to each other!”
Betty, 75, selected Humana: “I love earning rewards for staying healthy. Last year, I earned $500 in gift cards just for managing my diabetes well.”
When to Enroll
Annual Enrollment Period
October 15 – December 7
- Compare all available plans
- Switch plans if needed
- Coverage starts January 1
Medicare Advantage Open Enrollment
January 1 – March 31
- Switch between MA plans
- Return to Original Medicare
- One change allowed
Special Enrollment Periods
- Moving to new area
- Losing current coverage
- Qualifying for Extra Help
Questions to Ask Before Enrolling
- “What’s my exact copay for FreeStyle Libre/Dexcom supplies?”
- “Which DME suppliers are in-network?”
- “Is prior authorization required? How long does it take?”
- “Are there quantity limits on CGM supplies?”
- “What happens if I need supplies while traveling?”
Red Flags to Avoid
⚠️ Plans with very limited DME networks
⚠️ Excessive prior authorization requirements
⚠️ No mail-order option for supplies
⚠️ Poor customer service ratings
⚠️ Limited endocrinologist access
Making Your Final Decision
Consider Your Priorities:
If Cost is Most Important:
- Look for $0 premium plans
- Compare total annual costs
- Factor in all benefits
If Convenience Matters Most:
- Choose plans with mail-order
- Integrated health systems (Kaiser)
- Auto-refill programs
If You Travel Frequently:
- National networks (Anthem, United)
- Visitor/traveler programs
- Emergency coverage policies
Getting Personalized Help
Free Resources:
- Medicare.gov Plan Finder
- 1-800-MEDICARE
- State SHIP programs
- Senior CGM Support specialists
What We Can Do:
- Compare plans in your ZIP code
- Calculate total costs
- Check doctor networks
- Verify CGM coverage details
Future Trends in MA CGM Coverage
Coming improvements:
- Lower CGM copayments
- Expanded CGM brands covered
- Better technology integration
- Simplified prior authorization
Take Action Today
- List your priorities (cost, convenience, network)
- Check available plans in your area
- Compare top 3 options side-by-side
- Call for help if overwhelmed
- Enroll during appropriate period
Remember: The “best” plan depends on your individual needs, location, and budget. For more on Medicare Coverage Read On!
This information is not medical advice. Always consult your healthcare provider and verify coverage with your specific Medicare plan.
Need Help With Medicare Advantage Plans CGM Coverage?
Our specialists can help you find the best Medicare Advantage plan for CGM coverage in your area.
Call Now: 727-831-3729
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