Managing diabetes requires monitoring blood sugar levels, and glucose monitors are crucial for this process. The American Diabetes Association recommends a blood sugar level of less than 180mg/dl two hours after a meal and between 80 and 130mg/dl after fasting for people with diabetes.

But for those relying on Medicare, the cost of these monitors can be a concern. In this article, we’ll explore Medicare coverage of glucose monitors, eligibility criteria, and the types of meters available for Medicare beneficiaries.

Does Medicare cover glucose meters?

Yes, Medicare does cover glucose meters for beneficiaries who have been diagnosed with diabetes. Medicare Part B, which is the medical insurance component of Medicare, provides coverage for durable medical equipment (DME), including glucose meters.

To be eligible for coverage, you must meet certain criteria and follow Medicare’s guidelines. Generally, you must have a diagnosis of diabetes from your healthcare provider, and they must prescribe a glucose meter as part of your diabetes management plan. 

Medicare will typically cover the cost of a glucose meter, including the device itself, lancets, and test strips. However, it’s important to note that Medicare may have specific requirements regarding the frequency and quantity of supplies provided.

We recommend working closely with your healthcare provider and a Medicare-approved glucose meter supplier. They can assist you in navigating the process, including obtaining a prescription and selecting an approved glucose meter covered by Medicare.

How often does Medicare pay for a new glucose meter?

Medicare typically allows coverage for a new glucose meter every five years. This timeframe is based on Medicare’s guidelines for durable medical equipment (DME) coverage. So, generally speaking, you can expect Medicare to pay for a replacement meter after five years of using your current one.

It’s worth noting that there are situations where Medicare covers glucose monitors before the five-year mark. For instance, if your existing meter gets damaged, lost, or stops working properly, Medicare may make an exception and cover a replacement outside of the regular timeframe.

Are people with Medical Advantage plans covered for glucose monitors?

Regarding glucose monitors, Medicare Advantage plans generally offer coverage similar to Medicare Part B, meaning that glucose meters are covered. 

It’s worth mentioning that certain types of Medicare Advantage plans may have provider networks and can potentially reduce the amounts you pay for monitoring your glucose levels at home with a glucose monitor. The specific coverage details and any potential cost reductions will depend on the particular Medicare Advantage plan you have.

However, it’s essential to remember that when you’re enrolled in a Medicare Advantage plan, you are still part of the Medicare program. As a result, you must continue paying your Medicare Part B monthly premium, along with any premium the Medicare Advantage plan may charge.

Alternatively, if you decide to stay with Original Medicare, you have the option to sign up for a Medicare Supplement (Medigap) plan. Medigap plans can help cover Original Medicare’s out-of-pocket costs, including those related to glucose monitors and other items and services. 

It’s important to note that different Medigap plans may pay for varying amounts of these costs, such as copayments, coinsurance, and deductibles.

What brand of glucose meter is covered by Medicare in 2024?

As of 2024, there are different Medicare-covered glucose meter brands which are:

• The FreeStyle Libre 2 system;
• The FreeStyle Libre 14-day system;
• Senseonics Eversense;
• Medtronic Guardian;
• Dexcom G6;
• Dexcom G7.

We recommend utilizing a search tool provided by Medicare to learn which glucose meter brands are eligible for Medicare coverage. Simply input your zip code and specify the equipment type you are interested in (blood glucose monitor), and you will be presented with a list of results.

It’s important to note that while these brands are currently covered by Medicare, coverage can vary over time. We recommend you contact Medicare directly for the most accurate and up-to-date information regarding the specific brands of glucose meters or blood sugar monitors covered by the program.

Is POGO glucose meter covered by Medicare?

Neither Medicare nor Medicaid currently covers the Pogo Glucose Meter (POGO). 

However, the Pogo Glucose Meter coverage can vary depending on your private health insurance plan. Different insurance plans often have rules and guidelines for medical devices like glucose meters.

If you have private health insurance such as Medicare Advantage (Part C), we recommend contacting your insurance provider directly to determine the specific coverage details and requirements for the Pogo Glucose Meter. 

Does Medicare cover Continuous Glucose Monitors?

Yes, Medicare covers continuous glucose monitors (CGMs) for eligible beneficiaries.  CGMs are devices that monitor blood sugar levels continuously throughout the day and night, without the need for finger pricks.

Medicare Part B Continuous Glucose Monitors coverage

Medicare Part B provides coverage for CGMs for beneficiaries who meet certain criteria. To be eligible for coverage, you generally need to have a diagnosis of diabetes and meet specific requirements related to insulin use and blood glucose monitoring.

Medicare coverage of CGMs includes both the device itself and the necessary supplies, such as sensors and transmitters. 

However, it’s important to note that Medicare coverage guidelines can change over time, so it’s always a good idea to check with Medicare or your healthcare provider for the most up-to-date information regarding coverage and eligibility requirements.

Does Medicare cover CGM for type 2 diabetes?

Yes, Medicare does cover continuous glucose monitoring (CGM) devices for individuals with type 2 diabetes as of April 16, 2023. 

This significant policy change by the Centers for Medicare and Medicaid Services (CMS) expanded access to CGM devices and removed certain restrictions previously in place. The new coverage includes two groups of people:

• If you have type 2 diabetes and use insulin, whether it’s through injections or an insulin pump, and you have Original Medicare coverage, you are now eligible for CGM coverage.
• Even if you don’t use insulin, if you have type 2 diabetes and have a history of problematic hypoglycemia, you can also benefit from Medicare coverage for CGM devices.

It’s amazing to see that this policy change is estimated to impact approximately 2 million individuals with type 2 diabetes who meet these criteria.

Medicare CGM requirements 2023 and beyond 

First of all, the new policy no longer requires individuals with type 2 diabetes to meet the “three times daily insulin administration” requirement to qualify for CGM coverage. This means that all individuals with type 2 diabetes who are “insulin-treated” are now eligible for CGM coverage under Medicare.

Furthermore, the coverage has been extended to include individuals with non-insulin-treated diabetes who have a history of “problematic hypoglycemia.”

In addition to meeting the criteria mentioned above, clinicians are now required to document two additional factors to get CGMs covered under Medicare:

• The beneficiary or their caregiver has received proper training in using the CGM device, as evidenced by a prescription.
• The CGM is being prescribed in accordance with the indications for use approved by the FDA.

These new Medicare requirements for continuous glucose monitoring are expected to significantly improve access to CGM devices for eligible individuals with type 2 diabetes and ensure that the proper documentation is in place to support the coverage.

Conclusion

In 2024, Medicare ensures that beneficiaries have access to the necessary tools for managing their diabetes condition. Diabetes meters covered by Medicare help to alleviate the financial burden for individuals with the disease. 

As we have explored in this article, Medicare Part B provides coverage for glucose monitors, including both traditional blood glucose monitors and continuous glucose monitors (CGMs)

We recommend individuals with diabetes understand their Medicare benefits and take advantage of the coverage available to them. By doing so, they can better manage their condition and lead healthier lives.