What to Ask About CGM Coverage and Diabetes Supplies

A CGM can be useful, but the path to getting one may involve your healthcare professional, an insurance plan, and a supplier. Coverage depends on the plan and the details of your care. A short list of questions can help you understand the steps before you place an order.

Start With Your Healthcare Professional

Ask whether a CGM fits your care plan and which model's features meet your needs. A prescription or order may be required. Your clinician may also need to document your treatment and provide instructions for using the device. If you use Medicare, the healthcare professional must evaluate eligibility before ordering a CGM.

Ask Your Plan About the Benefit

A plan may handle a CGM under a medical equipment benefit or a pharmacy benefit. Ask how your plan covers the specific device and sensors, whether prior authorization is needed, and which suppliers are in its network. Also ask about deductibles, coinsurance, copays, and replacement supply rules. Check the plan's current written benefit details because coverage can change.

• Is this CGM covered under medical equipment or pharmacy benefits?
• Is a prescription, prior authorization, or recent clinical note required?
• Which suppliers and device models are covered?
• What will I owe for the initial device and ongoing sensors?
• How and when can I request replacement supplies?

If You Have Medicare

Medicare says Part B may cover a CGM and related supplies when a healthcare professional orders them and eligibility conditions are met. Its current page lists insulin use or a history of problems with low blood sugar, along with adequate training to use the device. Medicare also advises checking that the clinician and equipment supplier are enrolled and asking the supplier about assignment. Review Medicare's current CGM coverage page for the full rules and costs that apply to you.

Know What Happens After the Order

Ask who will request the prescription or supporting records, how you will be updated, and whom to contact if a document is missing. Once the device arrives, ask where to get setup instructions and how refills are handled. Medville Diabetes explains its supply process and lists its CGM products. You can contact our team with questions about next steps.

Sources and Further Reading

• Continuous glucose monitors — Medicare
• Continuous glucose monitoring — NIDDK