Updated: Sep 9, 2026
Key Takeaways
- Medicare eligibility is not based on high glucose alone.
- Use a Medicare-enrolled supplier and confirm assignment and cost sharing.
- Private-plan rules and cash prices need a device-specific written quote.
Medicare's coverage criteria
Medicare Part B may cover a continuous glucose monitor and related supplies if you have diabetes, your treating practitioner prescribes the device, and you either use insulin or have a documented history of problematic hypoglycemia meeting Medicare's criteria. Your practitioner must establish that you or a caregiver have sufficient training to use it.
A face-to-face or Medicare-approved telehealth visit is required within six months before ordering to assess diabetes control and the criteria. Continued coverage requires follow-up visits every six months documenting adherence to the treatment plan and CGM use. Review the official Medicare coverage page with your clinician.
Insulin use is therefore not the only route, but a general statement that a CGM would be helpful does not establish eligibility. A clinician should document the qualifying history rather than relying on high readings alone.
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What you might pay
Under Original Medicare, you generally pay 20% of the Medicare-approved amount after meeting the Part B deductible when the supplier accepts assignment. Confirm that both the prescribing practitioner and supplier are enrolled in Medicare. Ask the supplier to confirm coverage before shipment.
Illustration only: if the approved amount for a covered supply order were $300 and your deductible were already met, 20% would be $60. If $100 of deductible remained, your share would be $100 plus 20% of the remaining $200, or $140. These are assumed approved amounts, not retail device prices, and supplemental insurance may change your share.
Private coverage and cash quotes
Ask your insurer whether the specified model is covered through a pharmacy or equipment benefit, whether authorization is required, which supplier is in network, and what renewal documentation is needed. A policy from another insurer does not establish your coverage.
For an uninsured price, request a written quote identifying the model, sensors per month, replacement interval, receiver or transmitter, shipping, and any subscription. Compare the first year and later years separately. A promotional sensor price is not an annual total.
If coverage is denied
- Get the written denial and its reason, including the appeal deadline.
- Compare the reason with your plan's actual CGM policy.
- Ask your clinician or supplier to correct missing records, prescription details, or authorization information.
- Follow the appeal instructions and keep copies of submissions and call reference numbers.
For context on premiums and deductibles, see Medicare Part A versus Part B.
Frequently Asked Questions
Can I qualify without insulin?
Is a CGM free with Medicare?
ARTICLE SOURCES
Retire Companion requires writers to use primary sources to support their work. These include white papers, government data, original reporting, and interviews with industry experts. We also reference original research from other reputable publishers where appropriate. You can learn more about the standards we follow in producing accurate, unbiased content in our editorial policy.
- Medicare. Continuous glucose monitors
- Medicare. Medicare costs
- Centers for Medicare & Medicaid Services. Glucose monitors: Local Coverage Determination L33822
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