Medicare Part B covers certain equipment and supplies used to monitor blood glucose for people with diabetes, including traditional home blood glucose meters as well as qualifying continuous glucose monitors (CGMs). Understanding what equipment is covered, who qualifies for a CGM, how often supplies may be provided, and what costs remain for beneficiaries can make Medicare’s glucose-monitoring benefits much easier to navigate.
What Medicare Covers for Traditional Glucose Meters
Medicare Part B treats home blood glucose meters and many related supplies as durable medical equipment. Covered items can include the meter itself, test strips, lancets and lancet holders, and control solutions used to check the accuracy of the meter and strips. A doctor or other treating practitioner must prescribe the equipment and supplies for Medicare coverage to apply (source).
Medicare also places standard limits on quantities of testing supplies. Current guidance indicates that a person using insulin may generally receive up to 300 test strips and 300 lancets every three months, while someone who does not use insulin may generally receive up to 100 of each during the same period (source). Larger quantities may be covered when medically necessary, but additional documentation and requirements can apply.
Who Can Get a Continuous Glucose Monitor Through Medicare
CGMs measure glucose throughout the day using a sensor worn on the body. Medicare Part B may cover a qualifying CGM and related supplies for a person with diabetes when the device is ordered by a doctor or other eligible health care provider. To qualify, the beneficiary must either use insulin or have a documented history of problematic low blood sugar. The beneficiary or caregiver must also have enough training to operate the prescribed system correctly (source).
A health care provider must evaluate the beneficiary before ordering the CGM. Current Medicare coverage criteria also require an in-person or Medicare-approved telehealth visit within the six months before the initial order. For continued coverage, the treating practitioner must conduct another qualifying visit every six months to document continued use of the CGM and the diabetes treatment plan (source).
What CGM Equipment and Supplies Are Covered
When a qualifying CGM is covered as durable medical equipment, Medicare can also cover its associated supply allowance, including necessary sensors and transmitters. The exact components vary with the type of system being used. Some non-adjunctive CGM supply allowances can also include traditional blood glucose monitoring equipment when it is necessary for use with the system (source).
Medicare’s durable-medical-equipment rules are also important when choosing a CGM that works with a smartphone. A system that displays glucose information only through a smartphone does not meet the applicable DME requirement. However, beneficiaries may use a compatible smartphone, tablet, watch, or similar device alongside a qualifying durable CGM receiver. The important distinction is that the covered receiver or qualifying insulin pump must remain part of how the system is used (source).
How Much Do Medicare Beneficiaries Pay?
For covered glucose-monitoring equipment and supplies under Original Medicare, beneficiaries generally pay 20% of the Medicare-approved amount after satisfying the Part B deductible. This applies to covered CGMs as well as conventional glucose-monitoring equipment when the applicable Medicare requirements are met. (source)
Where the equipment comes from can affect what a beneficiary ultimately pays. Medicare advises beneficiaries to make sure their doctor and DME supplier are enrolled in Medicare and to ask whether the supplier accepts assignment. A participating supplier must accept Medicare assignment, while a nonparticipating supplier that does not accept assignment may result in higher out-of-pocket costs (source).
What to Check Before Ordering a Glucose Monitor
Before obtaining a meter or CGM, confirm that the prescription, device, supplier, and required supplies satisfy Medicare’s rules. For a traditional meter, it is useful to know how many strips and lancets are included under the standard allowance and whether your prescribed testing schedule requires a larger quantity. For a CGM, confirm your eligibility with the treating provider and make sure the selected system meets Medicare’s equipment requirements. (source)
It is also worth checking coverage before purchasing equipment independently. Medicare’s rules distinguish between conventional meters, qualifying CGM systems, covered supplies, and devices that do not meet DME requirements. Working with a Medicare-enrolled provider and supplier can help clarify what Medicare will cover and what portion of the cost will remain your responsibility (source).
Understanding Medicare Glucose Monitor Coverage
Medicare’s glucose-monitor coverage extends beyond continuous monitoring technology. Part B can cover traditional blood glucose meters and their testing supplies as well as qualifying CGMs and their associated supplies. Traditional meters have rules governing the amount of testing supplies provided, while CGMs involve additional eligibility, training, equipment, and follow-up requirements. (source)
For beneficiaries, the most important steps are to obtain the appropriate prescription, determine which type of monitor meets their medical needs, verify that the equipment qualifies for Medicare coverage, and use a Medicare-enrolled supplier. Understanding those requirements before ordering a device can make it easier to use the glucose-monitoring benefits available through Medicare Part B while avoiding unexpected coverage or cost problems.