Does Medicare Cover FreeStyle Libre and Other Continuous Glucose Monitors

Continuous glucose monitors (CGMs), such as the FreeStyle Libre and Dexcom systems, have revolutionized diabetes care. They make blood glucose (sugar) readings more convenient for people with diabetes. These systems use a small sensor, self-inserted under the skin, to test and record glucose levels throughout the day. CGMs have proven useful in managing both Type 1 and Type 2 diabetes and can replace finger sticks.

CGMs can detect changes in glucose levels and help prevent low blood sugar. They can also increase the time you spend in your target range. The real-time feedback enables you to take steps to improve your average blood glucose level, also known as hemoglobin A1C (HbA1C or A1C). They also decrease the risk of certain conditions, such as hyperglycemia and hypoglycemia.

Without insurance, CGMs can be costly. A startup kit - which includes an annual receiver, replaceable sensors, and a transmitter - can range from $2,000 to $7,000per year (without discounts). According to Forbes Health, CGMs cost $100 to $300 a month on average, or $1,200 to $3,600 annually.

Costs vary based on the CGM brand you use. But each system has three parts:

• Receiver or reader

• Replaceable sensors

• Transmitter (may be separate or part of the disposable sensor)

Thanks to original Medicare's Durable Medical Equipment (DME) benefit, (Part B) covers CGMs with a prescription if you meet certain criteria. Medicare Advantage (Part C) and state-administered Medicaid plans also cover CGMs. Some Tricare plans may also cover FDA-approved devices such as Abbott FreeStyle Libre 2 or Dexcom G6.

What are the requirements for Medicare to cover continuous glucose monitors?

Medicare Part B will cover an FDA-approved CGM if a healthcare professional says the device is medically necessary. You must also meet all of the following criteria:

1. Have diabetes

2. Have a history of recurrent or persistent hypoglycemic events or one level 3 hypoglycemic event

3. Receive insulin treatment regularly or use insulin pump therapy

4. Require frequent adjustments to insulin treatment based on blood sugar testing results

5. Visit a healthcare professional (in person or via telehealth) within 6 months of ordering a CGM (to determine whether the above criteria are met)

6. Receive follow-up care with a healthcare professional every 6 months for diabetes treatment plan adjustments

You must also have sufficient training to use the CGM as prescribed by the health professional providing your care.

How does Medicare cover continuous glucose monitors?

Original Medicare will pay for CGMs and related supplies only if the pharmacies and suppliers accept Medicare. In this case, you will be responsible for only the coinsurance. If you receive a CGM or supplies from a pharmacy or supplier that doesn't accept Medicare, you may have to wait for Medicare to reimburse you or pay in full. Typically, Medicare covers 80% of the approved costs. This means you can expect to be charged for the remaining 20% (coinsurance) after you've paid the Part B deductible.

Medicare Part B covers some CGMs with a prescription, including the FreeStyle Libre devices, Dexcom G6, and Dexcom G7. But not everyone is eligible for coverage. And there's no annual out-of-pocket maximum for original Medicare, so you may want to consider Medigap supplemental coverage. You may find the coverage you need for a CGM and related supplies with Medicare Advantage, because plans must meet or exceed the benefits offered by original Medicare.

Which continuous glucose monitors does Medicare cover?

Medicare covers CGMs that qualify as DME. Specific models include:

• Dexcom G6

• Dexcom G7

• Eversense E3

• FreeStyle Libre 14-Day

• FreeStyle Libre 2

• FreeStyle Libre 3

Medicare also covers CGMs integrated with an insulin pump, such as Medtronic's Guardian Connect system.

Who needs to use a continuous glucose monitor?

CGMs are primarily used by people who have Type 1 or Type 2 diabetes. But people diagnosed with gestational diabetes also may use CGMs.

Some people who do not have diabetes also use CGMs to:

• Monitor and improve their blood glucose levels

• Decrease the risk of developing diabetes, especially if they have prediabetes

• Boost their physical or mental performance (typically athletes)

• Build sustained healthy habits

It's important to note that healthcare professionals do not recommend CGMs for people without diabetes.

CGMs used to be available only with a prescription. But in March 2024, the FDA cleared Dexcom's Stelo glucose biosensor system as the first over-the-counter (OTC) CGM. It's expected to be available by the end of 2024. This means you'll be able to buy the device - which is recommended for people who don't take insulin - without a prescription. Abbott's Lingo, an OTC CGM for people who don't have diabetes, and Libre Rio, an OTC CGM for people who have diabetes but don't use insulin, were approved by the FDA in June 2024.

What are the different parts of a continuous glucose monitor?

Not all models are the same, but CGMs typically include three components:

• Sensors: This is self-inserted under the skin - on the upper arm, stomach, buttocks, or leg. It can be reinforced with adhesive skin patches. Sensors are as thin as a strand of human hair, are usually pain free, and last 10 to 14 days before they need to be replaced. They measure your glucose levels every few minutes.

• Transmitter: This small device goes on the sensor and wirelessly sends data to the reader or receiver. The updates are constant and automatic, so you don't have to prick your finger. If the CGM has a built-in insulin pump, the pump can receive this data and directly administer insulin.

• Receiver or reader: This portable component displays data, such as the glucose level and recent trends. The device also can send alerts if blood sugar is too high or low. Many people use their smartphone or another smart device as their reader.

How do the components affect the cost of a continuous glucose monitor?

Each component contributes to the overall cost. You'll need to buy replaceable sensors and a transmitter (unless it's part of the sensors). You may also need to get a new reader or receiver each year.

CGM costs vary depending on the brand and model. Abbott's FreeStyle Libre systems are some of the most affordable CGMs on the market. Most people with commercial health insurance spend less than $40 a month for sensors. If you have insurance and are asked to pay over $75 for two sensors, ask the company's customer care team for a voucher. If you self-pay for a FreeStyle Libre device, you may be eligible for a free sensor through Abbott's MyFreeStyle program.

Without discounts or insurance, FreeStyle Libre systems cost about $2,000 a year.

• The FreeStyle Libre 3 reader retails for $174 on average (without insurance) and lasts about 1 year.

• The FreeStyle Libre 2 doesn't need a separate receiver if you have a smartphone or another compatible device. Its reader can last for years and costs about $100.You'd also need to buy sensors. With a GoodRx discount, a 28-day supply of FreeStyle Libre 3 sensors would cost about $150 without insurance. That's about $1,950 a year.

Dexcom costs also vary by device. The Dexcom G6 system requires a smart device or an annual reader, a transmitter, and a monthly carton of sensors. The Dexcom G7 doesn't require a transmitter, but you'll need a reader or a smart device and sensors.

With commercial insurance, Dexcom G6 costs vary and can be as low as nothing out of pocket. Dexcom G7 starts at $89 a month. Once your health insurance kicks in, you'll be responsible for your copay.

Without insurance or discounts, the Dexcom G6 system costs about $7,000 a year with a receiver. The Dexcom G7 costs at least $5,000 annually if you use your smartphone as your reader. If you buy a separate receiver, expect to spend another $450.

Here's an estimated price breakdown of the Dexcom G6's different parts without insurance or coupons:

• $459 for one receiver (annual cost, but this is compatible with a smartphone and doesn't need a brand-specific reader)

• $300 for a transmitter that lasts 90 days ($1,200 a year)

• $466 for a month's supply of sensors ($5,592 a year)

Here's an estimated price breakdown of the Dexcom G7 without insurance or discounts:

• $450 for one receiver (annual cost if you don't use a smart device as the reader)

• $462 for a month's supply of sensors, which include transmitters ($5,544 a year)

GoodRx has an exclusive discount on the Dexcom G6 system that can save you $800 over a 3-month period. Eligible cash-paying consumers can get $200 off the monthly price for G6 sensors and $200 off the 90-day transmitter. For the Dexcom G7, this savings program could save you $210 per three sensors (a month's supply) and $240 per receiver.

Visit the GoodRx Dexcom G6 page or GoodRx Dexcom G7 page. Then click on the green button beside a participating pharmacy to find out if you qualify for these savings.

Dexcom has its own savings program that helps eligible cash-paying consumers save $200 on their Dexcom G6 transmitters. Dexcom also has a patient assistance program that makes their devices more affordable for underinsured or uninsured individuals.

Without insurance, the Eversense E3 CGM costs about $2,900 out of pocket. This includes the sensor, transmitter, and procedure to have the sensor inserted by a healthcare professional. Eversense has a PASS (payment assistance and simple savings) program. This will bring the cost down for eligible consumers. Through this program, you need to pay only $99 for the initial sensor, transmitter, and sensors. The program does not cover device insertion or removal.

Many health insurance plans, including Medicare, cover the Eversense E3 CGM. You can get prequalified online to find out your coverage options.

Which Medicare plans cover blood glucose meters?

Original Medicare typically covers DME, which includes blood glucose meters (glucometers). These devices work with test strips and require a finger prick to measure blood glucose levels.

Even if you don't use insulin, Medicare Part B will cover a glucometer and supplies if a doctor considers them medically necessary. Many Medicare Advantage plans also pay for glucometers and related diabetes supplies such as insulin pumps and sensors.

You also may be able to get a free glucometer from manufacturers because they profit from test strips for the devices.

Where can you find help paying for continuous glucose monitoring systems?

If you do not have insurance or your plan doesn't cover enough of your costs, here are a few ways to save on CGM devices and supplies:

• GoodRx pharmacy coupon for discounts on sensors and the 90-day transmitter for the Dexcom G6

• GoodRx coupon to save $210 per three Dexcom G7 sensors and an extra $240 on a G7 receiver

• GoodRx pharmacy coupon for discounts on sensors for the FreeStyle Libre 2 and FreeStyle Libre 3

• Low-cost or free trial period such as the Dexcom patient assistance program or Abbott's free trials for FreeStyle Libre devices (not available for people with state- or government-funded insurance, such as Medicare and Medicaid)

• Other manufacturer patient assistance programs