Continuous Glucose Monitors—better known as CGMs—are game-changers for folks managing diabetes especially if you’re on insulin. They give you real-time blood sugar updates without constant finger pricks. Medicare’s coverage for CGMs is evolving so if you’re a Medicare user and considering a CGM here’s what you need to know for 2025. Let’s break down the requirements and share a few tips from Henry Beltran the owner of Medicare Advisors Insurance Group LLC to help you navigate the sometimes confusing Medicare process.
What’s a Continuous Glucose Monitor (CGM) Anyway?
A CGM is a small wearable device that keeps track of your blood sugar levels all day without any fingersticks. There are two types Medicare generally looks at:
1. Therapeutic CGMs
These are the fully-loaded CGMs—worn 24/7—that send glucose readings straight to your phone or a separate monitor. They even alert you if your blood sugar’s off-track.
2. Non-Therapeutic CGMs
These guys are more for backup—meaning they aren’t the primary way to monitor blood sugar. Medicare doesn’t usually cover these fully so check your plan if you’re looking at one of these.
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What Does Medicare Want for CGM Coverage in 2025?
Medicare’s got specific hoops to jump through if you want CGM coverage. Here are the main ones:
Who’s Eligible?
- Diabetes Diagnosis
You’ll need a confirmed diabetes diagnosis and a history of needing frequent insulin adjustments. - Insulin Dependency
Medicare wants proof you’re using multiple daily injections (MDI) or an insulin pump. - Frequent Blood Sugar Testing
Medicare likes to see that you’ve been testing your levels four or more times a day. - Doctor’s Orders
You’ll need a treatment plan signed by your doctor saying the CGM’s necessary for managing your diabetes. - Enrolled in Medicare Part B
CGMs fall under Medicare Part B—not Part D or Medicare Advantage plans—so make sure you’re enrolled in the right part.
Quick Tip
If you’ve got a Medicare Advantage plan check with your provider since they might have some extra requirements on top.
Henry Beltran’s Advice on Eligibility
“Getting Medicare to cover a CGM can feel like trying to find a unicorn” says Henry Beltran from Medicare Advisors Insurance Group LLC. “But if you tick all the boxes it’s one of the best tools out there for diabetes management.”
Step-by-Step Guide to Getting a CGM with Medicare
Medicare’s rules can be tricky but here’s a simple guide to get you through the process:
- Chat with Your Doctor
Set up an appointment to talk about your need for a CGM. Your doctor has to note this in your records as “medically necessary.” - Get a Prescription
Make sure your doctor gives you a prescription for a CGM stating you need it because of diabetes and insulin use. - Pick an Approved Device
Medicare only covers certain CGM brands—mainly Dexcom and Freestyle Libre models—so be sure yours is on the list. - Enroll in Medicare Part B
CGMs are covered under Part B so double-check your enrollment. - Submit Your Documentation
Medicare wants proof of your blood sugar logs and other details from your doctor. - Work with an Approved Supplier
Not all suppliers accept Medicare so pick one that does—they’ll often handle a lot of the paperwork for you.
Common Pitfalls and How to Avoid ‘Em
Here’s where people often trip up with Medicare’s CGM requirements and how to sidestep those issues:
- Not Testing Enough
Medicare wants records showing you test at least four times a day. No documentation and your claim’s denied faster than you can say glucose. - Wrong CGM Brand
Medicare’s picky on which devices it’ll cover. “Going off-list is like ordering a burger at a sushi bar” says Henry Beltran with a grin. Not the best idea.
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What Medicare Covers and How Much It’ll Cost
Good news—Medicare usually pays 80% of the cost for approved CGMs. Here’s the breakdown:
- Medicare Covers: 80% of your CGM and its supplies
- You Pay: 20% coinsurance—unless you’ve got a supplemental plan to cover it
Supplies Medicare Covers
Beyond the CGM itself Medicare also covers the essential supplies including:
- Sensors
- Transmitters
- Receivers
What’s New for CGM Coverage in 2025?
Medicare has a few updates starting in 2025 that might make it a bit easier for people needing CGMs:
- Eased Testing Requirements
Medicare’s loosening up a bit—no need to submit daily testing logs if you’ve got a diabetes diagnosis and are insulin-dependent. - More Approved Devices
They’re considering more models like some advanced Freestyle Libre versions which may be covered now. - Telehealth-Friendly Prescriptions
Medicare will accept CGM prescriptions from telehealth visits—perfect if you live far from a specialist.
The Not-So-Great Parts of Medicare’s CGM Coverage
Medicare’s rules aren’t all sunshine and roses. Here’s a rundown of a few drawbacks—along with a humorous twist from Henry:
- Limited Device Choices
Medicare’s list of approved CGMs is about as short as a TV dinner’s ingredient list. Henry quips “It’s like showing up to a buffet only to find they’ve got two things on the menu.” - Endless Paperwork
If there’s one thing Medicare loves—it’s paperwork. Miss one page? Medicare could deny your claim quicker than a sugar spike. - 20% Coinsurance
Medicare’s 80-20 split means you’re left with 20% of the bill. As Henry says it’s like a “two-for-one deal that still leaves you footing a big chunk of the bill.”
FAQs on Medicare CGM Coverage in 2025
1. Can I change CGM brands if I don’t like mine?
Medicare’s strict about brands. You’d need a new prescription and a good reason to switch.
2. What if I don’t test four times a day?
Keep your logs ready. Medicare coverage might get dicey without proof of testing.
3. Does Medicare Advantage affect CGM coverage?
Yes it does—check with your plan for any different requirements.
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Final Thoughts from Henry Beltran
“Medicare’s CGM coverage is improving but it’s still got its quirks” says Henry Beltran. “Think of Medicare as that friend who overcomplicates everything. But once you get it figured out a CGM can make a world of difference.”
Need Help? Contact Medicare Advisors Insurance Group LLC
If you’ve got questions or need help navigating Medicare’s CGM rules in 2025 reach out to Medicare Advisors Insurance Group LLC. We’re here to make this process as smooth as possible so you can focus on managing your health.
When it comes to Medicare remember you’re not alone!
