Step-by-Step: How to Get CGM Through Medicare Without the Hassle

This article provides general information about Medicare coverage for CGM devices. Always consult with your healthcare provider and verify coverage with Medicare directly. Last updated: January 2025.

Learning how to get CGM through Medicare doesn’t have to be complicated. As a Medicare beneficiary with diabetes, you have the right to continuous glucose monitoring coverage when you meet the requirements. This step-by-step guide will walk you through the process clearly and simply.

Understanding CGM Medicare Coverage in 2025

A Continuous Glucose Monitor (CGM) is a small device that tracks your blood sugar levels day and night. It can help you avoid dangerous high or low blood sugar episodes and better manage your diabetes. Instead of multiple daily finger sticks, you simply scan a sensor on your arm to see your glucose levels and trends.

Important 2025 Update: Medicare has simplified CGM coverage requirements. You no longer need to test your blood sugar 4 times daily to qualify. This makes CGM more accessible for many seniors with diabetes.

Do You Qualify for CGM Through Medicare?

To get CGM through Medicare, you need to meet these basic requirements:

• Have Type 1 or Type 2 diabetes
• Be enrolled in Medicare Part B
• Have a prescription from your doctor
• Have visited your doctor in the last 6 months
• Be using insulin OR have documented problematic low blood sugar (multiple level 2 events below 54 mg/dL)

Pro Tip: Keep a record of any low blood sugar episodes (below 54 mg/dL). This documentation can help support your CGM coverage request.

Step-by-Step: How to Get CGM Through Medicare

Step 1: Schedule a Doctor’s Visit

Make an appointment with your doctor to discuss CGM. This visit is required for Medicare coverage and can be in-person or via telehealth.

What to tell your doctor:

• “I’d like to discuss getting a CGM through Medicare”
• Describe any challenges with finger stick testing
• Share any episodes of low blood sugar
• Explain how CGM could improve your diabetes management

Step 2: Get Documentation Ready

Your doctor will need to document:

• Your diabetes diagnosis (Type 1 or Type 2)
• Current diabetes treatment plan
• History of blood sugar levels
• Any episodes of severe low blood sugar
• Why CGM is medically necessary for you

Helpful tip: Bring a blood sugar log or meter showing your recent readings, especially any lows.

Step 3: Choose Your CGM Device

Medicare covers several CGM systems. Your options include:

Dexcom G7

• No finger sticks needed for treatment decisions
• 10-day sensor wear
• Works with smartphones

FreeStyle Libre 2 and 3

• 14-day sensor wear
• Smallest sensor available
• Optional alarms for highs and lows

Guardian Connect

• Works with certain insulin pumps
• Predictive alerts
• 7-day sensor wear

Your doctor will help choose the best device for your needs, considering factors like smartphone compatibility and ease of use.

Step 4: Get Your Prescription

Your doctor will write a prescription that includes:

• The specific CGM system
• How often you need sensors (usually monthly)
• Medical necessity documentation
• Your diagnosis codes

Important: The prescription must clearly state this is for “therapeutic” CGM use, not just monitoring.

Step 5: Find a Medicare-Approved Supplier

Not all medical supply companies can bill Medicare for CGM. You need a DME (Durable Medical Equipment) supplier that:

• Is enrolled with Medicare
• Has CGM in stock
• Can handle Medicare billing
• Provides training and support

Ways to find approved suppliers:

• Call 1-800-MEDICARE for a list
• Ask your doctor’s office for recommendations
• Search Medicare.gov supplier directory
• Contact manufacturers directly for authorized distributors

Step 6: Submit Your Order

When contacting the supplier, have ready:

• Your Medicare number
• Doctor’s prescription
• Recent doctor visit date
• List of current medications
• Preferred CGM system

The supplier will:

• Verify your Medicare coverage
• Contact your doctor for any missing documentation
• Process the Medicare claim
• Schedule delivery or pickup

Step 7: Complete Any Additional Requirements

Some suppliers may need:

• Signed forms acknowledging you understand how to use CGM
• Confirmation of your current address
• Agreement to Medicare’s coverage rules
• Setup of automatic refills for sensors

Understanding Your Coverage and Costs

What Medicare Covers

Medicare Part B typically covers:

• CGM receiver or compatible smartphone app
• Sensors (usually 1 month supply at a time)
• Transmitters (replaced as needed)
• Basic training on device use

Your Out-of-Pocket Costs

With Original Medicare:

• You pay 20% of the Medicare-approved amount
• Part B deductible applies ($240 in 2025)
• Costs vary by device and supplier

With Medicare Advantage:

• Copays vary by plan
• May have preferred suppliers
• Could have lower out-of-pocket costs

Medigap Coverage

If you have a Medigap (Medicare Supplement) plan, it may cover some or all of your 20% coinsurance, depending on your plan type.

Common Roadblocks and Solutions

“Medicare Denied My CGM”

Common reasons for denial:

• Missing documentation from doctor
• Prescription not specific enough
• Supplier not Medicare-approved
• Haven’t met Part B deductible

What to do:

• Request specific reason for denial in writing
• Work with your doctor to provide missing information
• File an appeal within 120 days
• Consider getting help from SHIP counselor

“My Doctor Isn’t Familiar with CGM”

Solutions:

• Bring CGM information to your appointment
• Ask for referral to endocrinologist
• Request diabetes educator consultation
• Share Medicare’s CGM coverage guidelines

“The Process Is Taking Too Long”

Speed up the process by:

• Following up with supplier weekly
• Ensuring doctor responds to requests quickly
• Having all documentation ready upfront
• Asking about expedited shipping

Tips for Success

Before Your Doctor Visit

1. Track your blood sugars for at least 2 weeks
2. Note any low blood sugar episodes with symptoms
3. Write down questions about CGM
4. Research which CGM might work best for you

During the Approval Process

1. Stay organized – Keep copies of all paperwork
2. Be persistent – Follow up regularly
3. Ask questions – Don’t assume anything
4. Document everything – Names, dates, and conversations

After Approval

1. Schedule training with your supplier or diabetes educator
2. Set up automatic refills for sensors
3. Keep prescriptions current – They expire after 12 months
4. Report any issues to your doctor and supplier

Frequently Asked Questions

How long does the approval process take?

Typically 1-2 weeks after your supplier receives all documentation. Some cases may take longer if additional information is needed.

Can I get CGM if I don’t use insulin?

Yes! If you have documented problematic hypoglycemia (multiple episodes below 54 mg/dL), you can qualify even without insulin use.

How often will Medicare replace my CGM supplies?

• Sensors: Monthly (amount depends on device)
• Transmitters: Per manufacturer guidelines (usually every 3-12 months)
• Receivers: When medically necessary

What if I want a different CGM than my doctor prescribed?

Discuss options with your doctor. They can write a new prescription if medically appropriate. Different devices have different features that may better suit your needs.

Can I travel with my CGM?

Yes! CGMs are TSA-approved. Request a travel letter from your doctor and bring extra supplies. Most CGMs work internationally.

Making the Most of Your CGM

Once approved, maximize your CGM benefits:

Learn the Features

• Set personalized alerts
• Use trend arrows to prevent highs and lows
• Share data with caregivers
• Review reports with your doctor

Maintain Your Coverage

• Keep doctor appointments every 6 months
• Renew prescriptions before they expire
• Report any changes in your condition
• Stay with Medicare-approved suppliers

When to Get Help

Don’t navigate this alone. Free help is available:

SHIP Counselors

• Free Medicare guidance
• Help with appeals
• Local resources
• Call 1-877-839-2675

Diabetes Educators

• CGM training
• Medicare documentation help
• Ongoing support
• Ask your doctor for referral

Manufacturer Support

• Device-specific help
• Medicare coverage assistance
• Patient assistance programs
• Training resources

Success Stories

Robert, 72: “I was intimidated by the process, but my supplier walked me through everything. I had my CGM within 10 days!”

Maria, 68: “After one denial, we figured out the prescription wasn’t specific enough. My doctor rewrote it, and Medicare approved it immediately.”

James, 75: “I didn’t think I’d qualify since I don’t use insulin, but my history of low blood sugars was enough. The CGM has been life-changing.”

Your Next Steps

1. Check your eligibility using the requirements above
2. Schedule a doctor appointment to discuss CGM
3. Choose a Medicare-approved supplier
4. Follow the steps in this guide
5. Don’t give up if you face obstacles

Remember, CGM coverage is your Medicare benefit. With the right documentation and a little persistence, you can get the diabetes management tools you deserve.

Final Thoughts

Getting CGM through Medicare may seem daunting, but thousands of seniors successfully navigate this process every month. The key is understanding the requirements, working with the right healthcare providers and suppliers, and staying organized throughout the process.

Your health is worth the effort. CGM technology can transform how you manage diabetes, providing peace of mind and better control. Take the first step today by talking to your doctor about CGM coverage.

Need Help with Medicare CGM Coverage?

Our specialists understand the Medicare CGM approval process inside and out. We can help you navigate requirements and get the supplies you need.

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