- Continuous glucose monitors can help people with diabetes manage their blood sugar levels.
- Medicare began covering these devices within the last decade.
- Abbott’s Freestyle Libre is a continuous glucose monitor that Medicare began covering shortly after its FDA approval in 2017.
A diabetes diagnosis can come with many difficult lifestyle changes, including frequent blood sugar checks.
To check blood glucose levels, people with diabetes must pierce their skin — often several times per day — and feed blood into a monitor for analysis.
Newer machines called continuous glucose monitors (CGMs) can help make this process easier, letting you keep track of your blood sugar levels in a less invasive way. One type of CGM is Abbott’s Freestyle Libre.
Medicare took some time to get on board with covering these devices. However, for the last few years, some people with diabetes have qualified.
Find out when these devices are covered and what you need to do to qualify.
The Freestyle Libre is one brand of CGM technology that is covered in some cases by Medicare.
CGMs have been covered by Medicare for some time under Medicare Part B.
Part B is the section of Medicare that covers outpatient care and some home medical equipment. As far as CGMs go, they fall under the Part B coverage for durable medical equipment (DME).
If you want to use a CGM, these devices will be covered instead of more traditional blood sugar monitors. The choice to use a CGM to monitor your blood sugar instead of a traditional monitor should be a shared decision between you and your doctor.
CGMs offer blood sugar monitoring that may be easier and more accurate than traditional methods.
The Freestyle Libre is a particular brand of CGM that has been approved by the FDA. Medicare made the choice to extend coverage to the device shortly after its FDA approval.
Some features of the Freestlye Libre include:
- factory calibration
- no need for blood sampling to calibrate manually
- reduced need for routine finger sticks
- no transmitter required, like other models, just a reader and sensor
- sensors can be self-applied to the back of the upper arm
- less interference with common over-the-counter medications like acetaminophen
- real-time blood sugar level monitoring
- allows you to see blood sugar level trends for the past 8 hours
For coverage of the Freestyle Libre under Part B’s DME rules, you must:
- Pay your monthly Prat B premium.
- Meet your annual Part B deductible.
- Have a doctor’s order for the device from a physician that participates in Medicare.
- Meet specific criteria for device coverage.
- Order the device from a supplier that participates in Medicare.
- Pay your share of the device cost approved by Medicare.
If you have a Medicare Advantage (Part C) plan, coverage will at least match what’s offered under Medicare Part B.
Medicare Advantage plans are private insurance products that combine the coverage of original Medicare, plus additional services for an extra cost.
Costs and services, as well as where you can receive care or order supplies, vary among different Medicare Advantage plans.
Basic Medicare coverage of the Freestlye Libre includes everything you’ll need to operate and maintain the device.
This includes a patch with a thin sensor that goes under your skin to measure blood sugar, as well as a reader that collects data from the patch. Abbott also has developed a smartphone app that works with the patches.
The patches worn with the Freestyle Libre system are good for 10 to 14 days. Medicare will cover the cost of refill items like additional patches.
Medicare will not cover a surplus of these supplies, though, and requires your supplier to contact you for specific needs about 2 week before the day you need the items shipped.
Automatic shipments of supplies for CGMs are not permitted by Medicare. The amount of supplies refilled have to match your individual anticipated future use and can’t be used to pay for supplies purchased in the past.
The Freestyle Libre device can be rented or purchased. There should be options for repair or replacement by your supplier, if needed.
While Medicare now covers all brands of CGMs, including the Freestyle Libre, there are some criteria you’ll have to meet, including:
- You must have a diagnosis of diabetes mellitus (type 2 diabetes).
- You must be already using a blood glucose monitor.
- You require blood glucose testing four or more times each day.
- You require insulin to keep your blood sugar within range.
- You need three or more injections of insulin each day or use a continuous insulin infusion pump.
- Your insulin treatment regimen needs frequent adjustments.
- You must have an in-person visit with the doctor who’s prescribing the CGM in the 6 months before ordering the device.
Beyond the initial criteria, you also have to meet ongoing requirements to ensure Medicare coverage:
- You have to meet with the doctor who ordered your CGM every 6 months after your first prescription is written.
- Your doctor must certify you meet the criteria for the device and make sure you’re following your CGM regimen and diabetes treatment plan.
Changes due to COVID-19
Medicare has changed its rules on in-person visits due to COVID-19. Telemedicine visits can now replace some in-person appointments.
If you have Medicare Advantage, you may want to contact your plan before ordering a CGM to find out about any additional requirements or cost savings that might be available.
To get started with a CGM, like the Freestyle Libre, ask your doctor for a list of local suppliers that participate in Medicare. You can also use Medicare’s supplier finder tool.
Once you receive your Freestyle Libre, your physician and the supplier can help you learn how to use it properly.
If you purchase the Freestyle Libre from a retailer — which would still require a prescription — you’d pay about $70 for the reader and $36 for the sensors, according to a 2018 article published on the American Journal for Managed Care website.
With Medicare Part B coverage, you’d pay 20 percent of the Medicare-approved amount after your premium and deductible are met. Medicare would pay the remaining 80 percent of the cost.
With private insurance plans, like Medicare Advantage, people pay anywhere from $10 to $75 per month for the Freestyle Libre sensors, according to the company.
Check with your plan about specific costs and coverage before ordering a CGM or additional supplies, so you’ll know what to expect to pay.
You may also want to check for coupons and other savings programs from the manufacturer. Manufacturers usually offer some type of savings program, like a free trial in the case of the Freestyle Libre.
Some retailers, state healthcare organizations, or community groups may also offer financial assistance for diabetic supplies. You can search online to find ones in your area.
When it comes to diabetes, care can get expensive quickly. Medicare covers many of the necessary costs of diabetes care, including supplies, medications, and appointments.
Diabetes care covered under Medicare Part B includes:
- blood sugar testing equipment and supplies, like lancets and test strips
- insulin pumps
- therapeutic shoes or inserts
- a one-time diabetes prevention program
- foot exams and treatments twice each year
- glaucoma screening once per year
- nutrition services and counseling
- annual preventive care and wellness visits
- laboratory testing
Medicare Part D covers:
- oral diabetes medications
- diabetic supplies like syringes and alcohol pads
- Medicare covers most aspects of diabetes care.
- CGMs may be an option to help you simplify your diabetes care regimen.
- Medicare covers CGMs like the Freestyle Libre, but make sure you meet the criteria for coverage before renting or buying the equipment.