Medicare Expands CGM Coverage for Type 2 Diabetes– What You Need to Know!

April 18, 2023

If you have non-insulin dependent Type 2 Diabetes and are on Medicare, good news! Continuous Glucose Monitors (CGMs) coverage has expanded. Read on to find out what you need to know and how to get started.

Medicare has expanded coverage for CGMs for non-insulin dependent Type 2 Diabetes patients.
The Medicare CGM update includes two significant policy changes for CGM coverage.
Read on to learn how to get a CGM on Medicare, why you should consider it, and how much it costs.

Does Medicare cover a CGM for Type 2 diabetes?

A: Medicare policies now include both insulin treated and non-insulin treated diabetes patients who have experienced at least one level 3 hypoglycemic event or recurrent level 2 hypoglycemic events that prompted their doctor to change their care plan. The criteria language for insulin and hypoglycemia no longer differentiates between Type 1 and Type 2 Diabetes, making it easier for physicians to prescribe CGMs.

What are the stages of Hypoglycemia?

Level 1 hypoglycemia: Blood glucose levels are below 70 mg/dL but above 54 mg/dL.
Level 2 hypoglycemia: Blood glucose levels are below 54 mg/dL.
Level 3 hypoglycemia: Also known as severe hypoglycemia, this occurs when a person requires assistance from another person due to an inability to self-treat. This may include confusion, seizures, or loss of consciousness.

Infographic illustrating the recent policy change by Medicare to include both insulin-treated and non-insulin treated Type 2 diabetes patients for coverage of Continuous Glucose Monitors (CGMs) who have experienced at least one level 3 hypoglycemic event or recurrent level 2 hypoglycemic events. The infographic includes images of insulin, a glucometer, a hospital patient, and a flowchart depicting the eligibility criteria for CGM coverage.

How Do I Get a CGM on Medicare??

A: Here are the recommended steps to get a CGM on Medicare:

If eligible, enroll in Medicare.
Find a clinician who accepts Medicare near you.
Get assessed for eligibility based on your blood glucose history.
Get referred to an FDA-certified CGM training location.
Complete the training to be covered.
Have a follow-up visit with your initial provider six months later.

Helpful Medicare Resources:

Click here to check which Medicare plans are available in your state,

Click here to find a clinician who accepts Medicare near you.

Is a CGM Worth it for Type 2 Diabetes?

A: Using Continuous Glucose Monitors (CGMs) can provide several benefits for Type 2 Diabetes patients. CGMs have been proven to reduce A1C levels and increase time spent in range, resulting in improved health and overall well-being. Recent studies show that CGM usage results in an average A1C reduction of 0.82% to 3.7%, depending on the duration of use. By lowering your A1C and striving to spend more time in range, you can experience better health overall.

Lowering your A1C and striving to spend more time in range can be major stressors when living with diabetes, but any time you can lower that A1C and raise your time in range, you will experience better health overall. If you’re struggling with mental health and diabetes, consider reaching out to a mental health professional, and read Anna’s story about her journey with diabetes and mental health.

"It's really nice to be able to see what my blood sugar is at anytime of the day without a finger stick. My finger used to get sore and black and blue," says Karen Seyler. Karen is a Type 2 diabetic and uses a Dexcom G6 to manage her blood sugar.

How Much Does a CGM Cost with Medicare??

A: Medicare covers 80% of approved costs for CGMs, meaning you just need to cover the remaining 20%. The out-of-pocket costs will vary depending on your state’s specific Medicare plan and which CGM system you choose. Currently, Medicare covers the Dexcom G6, Dexcom G7, and Freestyle Libre 3 CGM systems.

You can read more about cost on your state’s Medicare guidelines page, or check out this article from GoodRx. You’ll also need to find a pharmacist or supplier who will accept Medicare. To make things easy, you can find one here

Conclusion

TL;DR? If you’re a Type 2 diabetic on Medicare, the recent CGM coverage expansion is great news for you! With the changes in the Medicare policy on CGMs, it’s easier than ever to get a CGM device to help improve your blood glucose management and overall health. If you’re a Type 2 diabetic who uses insulin daily, regularly experiences a low blood sugar of 54mg/dL (also measured as 3 mmol/L), or has visited the hospital due to a low blood sugar level, Medicare may cover 80% of your costs for getting and using a CGM! Be sure to talk to your primary care doctor about your eligibility starting April 16th, 2023.

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