How Insurance Works for
Continuous Glucose Monitors (CGMs)
A simple guide to help you understand coverage, qualifications, and why we’re different.
Insurance coverage for CGMs has changed a lot in recent years. Here’s how it has expanded step by step:
2016
CGMs First Approved
coverage was limited to people with Type 1 diabetes.
2017
Intensive Insulin Therapy Only
Medicare began covering CGMs for people with Type 1 or Type 2 diabetes who were on intensive insulin therapy (multiple daily injections or an insulin pump).
2021
Fingerstick Requirement Removed
Medicare eliminated the rule requiring patients to check blood sugar with fingersticks four times a day. This made CGMs accessible to more insulin users.
2023
Major Expansion
Medicare broadened eligibility to include patients who:
1. Use any insulin regimen (even once-daily basal insulin), or
2. Have a history of problematic hypoglycemia (more than one severe low blood sugar <54 mg/dL despite treatment adjustments).
Who Qualifies Today
Most diabetics qualify for insurance-covered CGMs if they meet one of these conditions:
You inject insulin (any type, not just multiple times per day)
or
You’ve experienced more than 1 low blood sugar (below 54 mg/dL) event despite treatment adjustments from your provider
How We’re Different From Pharmacies
When you pick up diabetes supplies at the pharmacy, they’re billed through your Medicare Part D (pharmacy benefits). That’s why you might see:
- High co-pays
- Coverage denials
- Coverage denials
We’re different because we bill through your Medicare Part B (medical benefits). This is a separate part of your insurance that pharmacies can’t use.
- Under Part B, CGMs are often covered in full
- Even if your pharmacy said “not covered” under Part D, you may still qualify under Part B.
- We handle the paperwork and coordinate with your doctor so you don’t have to.
In short:
Pharmacy = Part D (more denials & costs)
