In many cases, glucose meters are covered by Medicare under Part B. They have become more accessible in recent years, thanks to some new laws regarding Medicare glucometer coverage.
Using a glucose monitor can help you manage your condition and may help prevent critical complications associated with diabetes. The information these devices provide allows you to monitor your blood sugar level and make informed decisions about your diet, exercise, and use of certain prescription medications, such as insulin.
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Advancements in Glucose Monitoring Mean More Device Options
Diabetes is a chronic disease that occurs when your body does not produce enough insulin or cannot properly use the insulin it produces. This causes too much sugar to remain in your bloodstream, potentially leading to serious health problems such as kidney disease, heart disease, and vision loss.
This condition is quite common among American adults. Currently, more than 25% of U.S. adults over age 65 have diabetes, and 50% have pre-diabetes, a condition that may develop into diabetes.
Those with diabetes must monitor their blood glucose levels and sometimes need to document and share this information with their healthcare providers. This is done using a glucometer or a glucose meter, which measures the amount of glucose in your blood.
At one time, the process of testing your blood sugar was both inconvenient and painful.
Traditional glucose monitors require you to prick your finger and place a drop of blood on a strip, which is then read by the glucose meter. However, thanks to technological advancements, it’s easy and convenient to monitor your blood sugar levels using a continuous glucose monitor.
These devices use implantable sensors, known as filaments, and hand-held readers for continuous, accurate, and pain-free monitoring. Medicare also now covers various types of glucose monitors for individuals who meet the requirements.
Which Glucose Meters Are Covered by Medicare?
Medicare glucometer coverage falls under the durable medical equipment (DME) category, which is covered under Medicare Part B. This allows covered individuals to access glucose meters and the necessary supplies, such as blood sugar test strips and lancets, even if they are not taking insulin.
To be eligible for coverage, your doctor must believe the meter is medically necessary and provide you with a prescription. In some cases, you may be able to receive a Medicare-covered continuous glucose monitor and related supplies if you meet certain conditions.
In either case, you must purchase your Medicare diabetic testing supplies and equipment from a pharmacy or medical equipment supplier enrolled in Medicare. Choosing a pharmacy or supplier that accepts assignment can also save you money. Assignment implies that the provider has agreed to accept the Medicare-approved amount without charging you an additional cost.
The following chart compares the Medicare-covered glucose meters that may be available to you:
Covered By Medicare? | How It Works | Drawbacks | |
|---|---|---|---|
Glucometer | Yes; covered in Part B | Prick your finger to draw a drop of blood, which is then placed on a test strip to be read by a meter | Painful to draw from fingertips |
Continuous Glucose Meter (GCM) | Yes; covered in Part B | Uses a sensor placed below the skin to continually monitor blood sugar levels. Sends readings to a small device worn on the body, a smartphone, or smartwatch. Provides alerts when blood sugar is too low or too high. | Can be expensive, and sensors typically need to be replaced every 7 to 14 days. May need to use traditional monitor to confirm accuracy or program your device. |
Alternate Site Testing | Yes; covered in Part B | Draw a drop of blood from less-sensitive body parts, such as the thigh, arm, or palm of the hand, then place it on a test strip to be read by a meter. | Less accurate than fingertip samples when blood sugar is falling or rising rapidly. |
Glucometer
Glucometers are covered under Medicare Part B, even if you do not use insulin. These devices work by analyzing a drop of blood drawn from your fingertip. In addition to the meter itself, Medicare Part B also covers the necessary test strips, lancets, lancet devices, and control solutions, which allow you to check the accuracy of your strips and equipment.
If you’re not on insulin, Medicare will still cover diabetes test strips. However, Medicare only covers 100 strips and 100 lancets per month for non-insulin users unless your doctor determines that additional supplies are medically necessary.
Coverage Criteria
To be eligible to have your glucometer covered by Medicare, your doctor must believe it is medically necessary and provide you with a prescription. You may also need to document your testing frequency if you receive additional test strips and lancets beyond what is normally covered.
Benefits
If you meet the requirements for Medicare glucometer coverage and purchase from an enrolled supplier that accepts assignment, your only cost is typically your coinsurance amount after you have met your annual deductible.
Drawbacks
You must ask for refills for your supplies each time, as Medicare does not cover supplies sent to you automatically. You also need a new prescription every 12 months.
Continuous Glucose Monitor (GCM)
A continuous glucose monitor (CGM) consists of a sensor placed on your arm and a reader device that receives information from the sensor. This allows you to get a new blood sugar reading every 5 minutes, so you can instantly see how your food, sleep, stress, and other situations impact your blood sugar levels. The meter can also trigger an alert when your blood sugar gets too high or too low.
These devices and the necessary supplies are covered by Medicare Part B as long as you meet the requirements.
Coverage Criteria
Until recently, to be eligible for a Medicare-covered CGM, you typically were required to be using insulin and need to adjust your insulin dosage or regimen frequently. However, beginning on April 16, 2023, Medicare is expanding CGM coverage to individuals with Type 2 Diabetes, including those treated with insulin and certain non-insulin-using individuals with a history of “problematic hypoglycemia.”
This update also removes a previous requirement that individuals must need frequent adjustments to their insulin treatment regimen, opening up eligibility for people using basal insulin (long-lasting insulin injected once or twice a day).
Medicare still requires covered individuals to have routine in-person visits with their doctor to maintain eligibility.
Benefits
CGMs can be expensive. However, when Medicare covers the devices and supplies, you’re typically only responsible for your coinsurance amount after your deductible has been met.
Drawbacks
You must meet eligibility requirements to receive Medicare coverage for your continuous glucose monitor. Further, you’ll need to request your supplies each time you need them rather than having them sent to you automatically.
Alternate Site Testing
Alternate site testing works in much the same way as a traditional glucometer, except that it allows blood samples to be drawn from other, less-sensitive areas of the body. These devices are also covered under Medicare Part B as durable medical equipment.
Coverage Criteria
Alternate site testing devices follow the same Medicare glucometer coverage rules as traditional finger stick glucometers. To receive coverage for your device, you must have been diagnosed with diabetes and have a prescription. Alternate site testing devices are covered under Medicare Part B regardless of whether you use insulin.
Benefits
The Medicare coverage for these devices is the same as for traditional glucometers. However, they offer a less painful alternative for monitoring blood sugar levels.
Drawbacks
As with a traditional glucometer, you must renew your prescription every 12 months. Supplies must also be requested each time you need them.
The Cost of Glucose Meters with Medicare
Glucometers, continuous glucose monitors, and the necessary supplies are considered durable medical equipment under Medicare Part B. As long as your provider accepts assignment, after you meet your Medicare Part B annual deductible ($226 in 2023), you’re responsible for 20% of the Medicare-approved amount.
For example, if the Medicare-approved amount for your CGM was $1,000 and you had already met your deductible for the year, you can expect to pay 20% of that amount, or $200.
If the Medicare-approved amount for your glucometer was $40 and you had not yet met your deductible, your out-of-pocket cost is the full $40. However, once your deductible is met, your cost drops to 20% of $40, or $8.
How Do Other Medicare Options Cover Glucose Meters?
If you have Original Medicare (Medicare Parts A and B), your glucose meters and supplies are covered under Part B. However, other Medicare programs may also offer coverage for glucose meters and supplies. This includes Medicare Advantage and Medicare Supplement plans.
Medicare Advantage
Medicare Advantage offers the same coverage as Original Medicare, but private insurers provide it instead of through the government. Medicare Advantage plans are mandated to provide the same coverage as Original Medicare and therefore offer coverage for glucometers and CGMs.
Medicare Supplement, or Medigap
Medicare Supplement insurance, also known as Medigap, is additional coverage that helps offset a Medicare recipient’s out-of-pocket costs. This can help cover the coinsurance costs for your Medicare-covered glucose meters, glucometers, and supplies.
For example, if you need a $1,000 CGM and you’ve already met your annual deductible, your 20% coinsurance is $200. However, your Medigap plan may cover this in full or in part, reducing or eliminating your out-of-pocket cost.
How to Get a Medicare-Covered Glucose Meter
If you’ve been diagnosed with diabetes and have Medicare, you can receive a Medicare-covered glucose meter by following these steps.
1. Choose a Medicare-Approved Meter That Suits Your Needs and Comfort
It may be helpful to begin the process by researching your options and deciding which types of Medicare-approved meters will likely meet your needs and comfort level. This may include evaluating each option based on cost, convenience, accuracy, and the potential physical pain involved in the testing procedure.
2. Speak With Your Doctor
Medicare requires you to have a prescription before it covers the cost of a glucose meter and supplies. Meet with your doctor to discuss whether a glucometer or continuous glucose monitor is medically necessary and that you meet the Medicare requirements. You may also discuss the meter you’ve selected to confirm it’s appropriate for your needs.
3. Find an Enrolled Pharmacy or Supplier
Medicare glucometer coverage requires you to purchase equipment and supplies from a pharmacy or supplier enrolled in Medicare. In addition, using a pharmacy or supplier that accepts assignment prevents you from having to pay additional expenses beyond your Medicare deductible and coinsurance. Be sure to ask whether the pharmacy or supplier meets these requirements before placing your order.
4. Maintain Your Prescription
Medicare requires you to get a new prescription every 12 months to continue receiving coverage for your testing strips and lancets. If you have a Medicare-covered CGM, you may also be required to meet in person with your doctor regularly. To avoid a potential lapse in coverage, it’s essential to understand the requirements and ensure you meet them.
What to Do if You Have a Non-participating Pharmacy
If it’s not possible to find an enrolled supplier or pharmacy nearby your home, you may be able to order your meters and supplies through the mail.
Medicare requires you to purchase your glucometers, CGMs, and supplies from a pharmacy or medical equipment provider enrolled in Medicare. If you choose a provider not enrolled, Medicare does not cover the costs. Enrolled pharmacies and suppliers also must submit claims for monitors, test strips, and other covered items to Medicare. Individuals are not allowed to submit these claims themselves.
Medicare Coverage of Other Diabetes Management Supplies and Insulin
While glucose meters are an important part of diabetes management, other equipment, treatments, and medications may also be necessary. The good news is that much of the needed treatment is covered under Medicare.
Medicare Part B typically covers the following:
- Glucose monitor supplies (lancets, test strips, lancet devices)
- Foot exams and treatments, if you meet certain conditions
- Therapeutic shoes and inserts, when medically necessary
- Glaucoma tests, once per year if you are at high risk of glaucoma
- External durable insulin pumps and insulin, if you meet certain conditions
Medicare Part D typically covers the following:
- Anti-diabetic drugs
- Insulin that is not administered with an insulin pump
- Diabetes supplies (needles, syringes, inhaled insulin devices, gauze, alcohol swabs)
In addition, the following are typically available at no cost:
- Diabetes screening tests: You can receive up to 2 free screenings per year if your doctor determines you’re at risk for diabetes (your deductible and a 20% coinsurance generally apply to the doctor’s visit.)
- Medicare Diabetes Prevention Program: This is a once-per-lifetime health behavior change program designed to help minimize your risk of developing diabetes.
- Annual wellness visit: This differs from a physical examination, but usually includes discussion about diabetes risks.
- Medical nutrition therapy (MNT) services: This benefit is for individuals with diabetes or kidney disease.
Putting It All Together
Diabetes is a severe condition that requires ongoing medical management. Luckily, traditional finger-stick glucometers and continuous glucose monitors are now covered under Medicare for individuals who meet the necessary requirements.
Under Medicare Part B coverage, recipients are typically responsible for paying 20% of the Medicare-approved cost of these devices and supplies after meeting the annual Medicare Part B deductible. However, it is necessary to have a prescription and purchase the items from a Medicare-enrolled pharmacy or supplier. Otherwise, Medicare does not cover the costs. If you need a glucose monitor to manage your condition, speak to your doctor about your options.