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Understanding Medicare Part B CGM requirements doesn’t have to be complicated. If you’re a senior with diabetes wondering if you qualify for a Continuous Glucose Monitor (CGM) through Medicare in 2025, you’re in the right place. We’ll walk you through the updated requirements step-by-step.
Do You Meet Medicare Part B CGM Requirements in 2025?
Medicare has simplified CGM coverage requirements for 2025, making it easier for many seniors to qualify. Here’s what you need to know:
Basic Qualification Checklist:
- You have Medicare Part B coverage
- You have been diagnosed with Type 1 or Type 2 diabetes
- You meet with your doctor in person or via telehealth at least every 6 months
- You or your caregiver can operate the CGM device
Treatment Requirements – You Must Meet ONE of These:
To qualify for CGM coverage, you must either:
- Use insulin for diabetes management (any frequency), OR
- Have documented problematic hypoglycemia:
- 2 or more Level-2 episodes (blood sugar below 54 mg/dL), OR
- 1 or more Level-3 episode (requiring assistance from others)
Step-by-Step Guide to Getting CGM Coverage
Follow these steps to secure your Medicare CGM coverage:
- Schedule a doctor’s appointment (in-person or telehealth)
- Bring documentation of your diabetes management
- Discuss CGM options with your healthcare provider
- Get proper documentation of qualifying conditions
- Obtain a prescription for a Medicare-approved CGM
Common Questions About Medicare CGM Coverage
What Does Medicare Part B Cover for CGM?
When you qualify, Medicare typically covers:
- 80% of the approved amount for your CGM device
- 80% of monthly supplies (sensors, transmitters)
- Replacement devices when medically necessary
How Often Do I Need to See My Doctor?
Medicare requires:
- Initial visit (in-person or telehealth) for CGM prescription
- Follow-up visits every 6 months to maintain coverage
Cost Considerations
Your out-of-pocket costs typically include:
- Medicare Part B deductible ($240 in 2025)
- 20% coinsurance for approved amounts
- Any additional costs if your supplier doesn’t accept assignment
How to Get Started Today
Ready to explore your CGM coverage? Here are three simple steps:
- Call us at 888-649-5705 to verify your eligibility
- Use our online Coverage Checker tool
- Download our free Medicare CGM Guide
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