Medicare CGM Coverage: Coverage for Insulin Pumps & Continuous Glucose
Key Takeaways
- Medicare Part BMedicare Part B is medical insurance that covers Medicare-approved services — such as medically necessary treatment and preventive services — and certain other costs, like durable medical equipment. Medicare Part B is part of Original Medicare. covers part of the cost of glucose meters and supplies.
- Medicare Part B covers part of the cost of some CGM systems.
- If you use an insulin pump, the type you choose will determine which part of Medicare covers it.
- Medicare covers part of the cost of insulin if an insulin pump is medically necessary for your care.
If you have diabetes, you may be wondering if Medicare covers the at-home testing supplies you need to manage your condition effectively.
Diabetes can be a challenging diagnosis that requires daily testing and regular insulin injections. If you are eligible for Medicare, it will cover many at-home diagnostic tools. In some instances, Medicare may also cover insulin.
Read on to learn what Medicare will pay for and what your cost-sharing responsibilities will be.
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Does Medicare Cover Glucose Meter and Supplies?
Glucose meters are portable devices that measure blood sugar. They are also known as glucometers.
You must meet the following requirements for Medicare to cover your glucose meter:
- You have been diagnosed with diabetes
- Your doctor has stated that a professional can train you to use this device
- If you can’t operate the device, another person will be available to do it for you
- The monitor is for use in your home, rather than clinical use
- lancet devices
- lancets
- blood sugar testing strips
- glucose control solutions that check the accuracy of your at-home equipment
Typically, a person who uses insulin will have Medicare coverage for 300 test strips and 300 lancets every three months. If you don’t use insulin, you’ll have coverage for 100 test strips and 100 lancets every three months.
If your physician can prove that it’s medically necessary for you to receive more supplies than your eligibility indicates, you may be able to get them.
For coverage to take place, your physician and medical supplies provider must both accept Medicare assignment.
If you have a Medicare Advantage (Part C) plan, your plan will cover at least as much as Original Medicare does. In some instances, it may also provide richer coverage of your meter and supplies.
Does Medicare Cover Diabetic Sensors?
Diabetic sensors are also referred to as glucose sensors. They’re used to measure blood sugar as part of a CGM (continuous glucose monitoring) system. Medicare does not cover every CGM system. If your system is covered, your diabetic sensor will be, too.
Diabetic sensors are professionally inserted under the skin, usually on the abdomen or arm. They take continual glucose measurements, which you can monitor at a glance. You can share your readings with a mobile device, such as your smartphone.
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Are Glucose Monitors Covered by Medicare?
Medicare Part B covers Glucose monitors as durable medical equipment that your doctor has prescribed for your use at home.
You will need to get your monitor from a Medicare-approved supplier. Medicare will determine if your monitor must be rented or purchased. In some instances, you may be able to choose between those options.
As part of a CGM system, glucose monitors connect wirelessly with insulin pumps. They provide all-day readings of your blood sugar levels without the need for most finger pricks.
What Glucose Monitor Is Covered by Medicare?
Not every glucose monitor is covered by Medicare. Several CGM systems that contain glucose monitors are available for beneficiaries. They include:
- Eversense
- Freestyle Libre
- Dexcom G6
What Brand of Glucose Meter Is Covered by Medicare?
Most blood glucose meters designed for at-home use are covered under Medicare Part B. These include multiple brands, such as:
- OneTouch
- Accu-Chek
- FreeStyle
Is the FreeStyle Libre covered by Medicare?
If a Medicare-approved physician prescribes the FreeStyle Libre CGM system, Medicare will cover the device if you qualify. You may purchase or rent a FreeStyle Libre from a Medicare-approved provider only.
There are requirements to qualify, including:
- You have a diagnosis of diabetes
- You require blood glucose testing at least four times daily
- You require insulin to keep blood sugar levels within the appropriate range
- You need at least three daily insulin injections
Since CGMs utilize inserted sensors, they eliminate the need for most finger pricks. The sensors provide a sense of freedom for many people.
How much does FreeStyle Libre cost with Medicare?
If you have Medicare Part B, you can expect to pay 20% of the Medicare-approved cost of a FreeStyle Libre. You will also be responsible for meeting the Part B deductible, plus your monthly premium costs.
If you have a Medicare Advantage plan, your costs for this system may vary.
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Does Medicare Pay for Insulin Pump Supplies?
Insulin pumps are small devices that help you manage diabetes. People with type 1 diabetes mostly use them.
Medicare covers the cost of insulin pump supplies if your doctor has determined that an insulin pump is medically necessary for your care. These supplies include:
- Insulin
- Tubing
- Batteries
- Sensors
How Much Does it Cost to Get an Insulin Pump?
Medicare covers 80% of the Medicare-approved cost of insulin pumps. You are responsible for the other 20%, plus the Part B deductible and monthly premiums.
Your pump must be prescribed by a Medicare-approved physician and purchased or rented from a Medicare-approved medical supplier for Medicare to cover it.
Which Insulin Pumps Are Covered by Medicare?
Medicare coverage for insulin pumps is determined by the type of pump you have. Tubed pumps are durable medical equipment. They are covered by Medicare Part B.
Tubeless pumps are patches that contain insulin. They are covered by Medicare Part D (prescription drug coverage).
Does Medicare Cover T Slim Insulin Pump?
If you are eligible for Medicare and meet other requirements, Medicare Part B will cover the T Slim Insulin Pump. These requirements include being diagnosed with diabetes and requiring at least three insulin injections daily.
Sources
- Insulin. Medicare.gov.
- Medicare costs at a glance. Medicare.gov.
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