| Coverage Program | Medicare Part B (DME) |
| Medicare Pays | 80% after deductible |
| Patient Coinsurance | 20% |
| 2026 Part B Deductible | ~$257/year |
| Approved Devices | Dexcom G7, FreeStyle Libre 2/3, Guardian 4 |
| Prescription Renewal | Required annually |
Key Takeaways
- Medicare Part B covers therapeutic CGMs and sensors as durable medical equipment (DME) in 2026.
- You must have diabetes and a treating physician order to qualify.
- After meeting your Part B deductible, Medicare pays 80%; you pay 20%.
- Approved CGM brands include Dexcom G7, Abbott FreeStyle Libre 2/3, and Medtronic Guardian.
- Suppliers must be Medicare-enrolled DME suppliers to bill correctly.
What Medicare Covers for CGM Sensors in 2026
Medicare classifies continuous glucose monitors and their sensors as therapeutic durable medical equipment (DME) under Part B. This means both the CGM receiver/transmitter and the disposable sensors are covered β not just the device itself. Insulin-requiring patients and non-insulin users who meet clinical criteria are both eligible following policy expansions.
Covered CGM Systems (2026)
| Device | Sensor Wear Time | Medicare Status |
|---|---|---|
| Dexcom G7 | 10 days | Covered |
| Abbott FreeStyle Libre 2 | 14 days | Covered |
| Abbott FreeStyle Libre 3 | 14 days | Covered |
| Medtronic Guardian 4 | 7 days | Covered (with pump) |
Eligibility Requirements
To qualify for Medicare CGM coverage in 2026, you must meet all of the following criteria:
- Enrolled in Medicare Part B
- Have a diagnosis of diabetes mellitus
- Treating physician provides a written order and sees you face-to-face within 6 months prior
- Your doctor documents the medical necessity in your chart
- You use a Medicare-enrolled DME supplier
Since the 2023 CGM coverage expansion, Medicare no longer requires patients to use insulin or perform finger-stick testing a minimum number of times daily. Non-insulin-dependent patients with type 2 diabetes can now qualify if their physician deems CGM medically necessary.
Cost Breakdown for 2026
Under Medicare Part B, the standard cost-sharing structure applies:
- Part B Deductible: $257/year (2026 projected)
- Medicare pays: 80% of the approved amount after deductible
- Your share: 20% coinsurance
- With Medigap/Supplement: Your 20% may be fully covered
Monthly out-of-pocket for sensors typically ranges from $20β$60 depending on the CGM brand and your supplement plan. Supplies purchased through MDS Diabetes are fulfilled by Medicare-enrolled suppliers, streamlining your billing process significantly.
How to Get Your CGM Sensors Covered
Step-by-Step Process
- Visit your doctor β Request a CGM order and ensure medical necessity is documented.
- Choose a Medicare-enrolled DME supplier β Only enrolled suppliers can bill Part B directly.
- Submit your prescription β The supplier verifies eligibility and obtains prior authorization if needed.
- Receive sensors monthly β Sensors are typically shipped on a recurring basis.
Common Coverage Pitfalls to Avoid
- Buying sensors from a non-enrolled retailer β Medicare will not reimburse you.
- Expired or missing physician orders β Orders must be renewed annually.
- Using a CGM not on Medicare's approved list β Verify before ordering.
- Skipping face-to-face visit requirements β Documentation gaps cause claim denials.
Medicare Advantage (Part C) and CGMs
Medicare Advantage plans must cover everything Original Medicare covers, including CGM sensors. However, plans may have preferred supplier networks and formulary tiers. Always verify your specific Advantage plan's DME supplier network before ordering to avoid unexpected costs.