Medicare covers CGM sensors, test strips, and insulin pumps for diabetics. Learn what Part B and Part D cover and how to get approved.
What Medicare Covers for Diabetes
Medicare provides substantial coverage for diabetes supplies through two programs: Part B and Part D. Understanding which program covers your specific supplies is essential for minimizing out-of-pocket costs.
Medicare Part B Coverage
Part B covers diabetes supplies as Durable Medical Equipment (DME). This includes CGM sensors like the Dexcom G7, blood glucose meters, test strips for insulin-treated patients, and insulin pumps. Part B pays 80% of approved costs after your deductible, leaving you responsible for 20%.
Getting CGM Approved Under Part B
To get a CGM covered under Medicare Part B, you need a doctor order, a diabetes diagnosis, and documentation that you use insulin or have hypoglycemia unawareness. The process typically takes 2-4 weeks.
Medicare Part D Coverage
Part D covers prescription medications including insulin, oral diabetes medications, and insulin pens. Each Part D plan has its own formulary, so check your specific plan for coverage details.
Medicare Advantage (Part C)
Medicare Advantage plans often provide additional diabetes benefits beyond Original Medicare, including lower copays for CGM supplies and extra wellness benefits.
What Medicare Does Not Cover
Medicare generally does not cover insulin coolers, CGM overpatches, or lifestyle accessories. These can be purchased at mdsdiabetes.com at affordable prices, and many qualify for FSA or HSA reimbursement.
Prior Authorization for CGM
Most Medicare plans require prior authorization for CGM sensors. Work with your doctor to submit the required documentation including your diagnosis, insulin use history, and medical necessity letter.