Navigating Medicare CGM prior authorization for UnitedHealthcare (UHC) and Humana plans doesn’t have to be overwhelming. As a Medicare beneficiary managing diabetes, understanding how to get your Continuous Glucose Monitor (CGM) approved is essential for maintaining your health and peace of mind.
Understanding Medicare CGM Prior Authorization Basics
Prior authorization means getting approval from your Medicare Advantage plan before they’ll cover your CGM. Both UnitedHealthcare and Humana require this step to ensure the device is medically necessary for your diabetes management.
Do You Qualify for CGM Coverage?
Medicare has specific requirements for CGM coverage in 2025:
- Diagnosed with Type 1 or Type 2 diabetes
- Regular visits with your healthcare provider (at least every 6 months)
- Either using insulin OR having documented problematic hypoglycemia
- Ability to use the CGM system safely (you or your caregiver)
Step-by-Step Prior Authorization Process
For UnitedHealthcare Medicare Advantage Members:
- Visit your doctor to confirm you meet Medicare’s CGM criteria
- Your doctor submits the prior authorization request to UHC
- Include recent medical records showing diabetes management
- UHC typically responds within 14 calendar days
For Humana Medicare Advantage Members:
- Confirm your plan requires prior authorization (not all do)
- Your doctor submits clinical documentation to Humana
- Expect a response within 72 hours for urgent requests
- Standard requests typically process within 14 days
[Content continues with detailed sections on documentation requirements, troubleshooting tips, appeal rights, and coverage renewal process…]
Need Help with Medicare CGM Coverage?
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