Does Insurance Cover CGM? Medicare, Medicaid, and Commercial Plans Explained

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Insurance coverage for CGMs has expanded significantly since 2020. Here is the current coverage landscape for Medicare, Medicaid, and commercial insurance in the US.

Medicare Part B Coverage (2026)

Medicare covers CGMs as Durable Medical Equipment (DME) for beneficiaries who:

  • Have diabetes (Type 1 or Type 2)
  • Use insulin (any type — including basal-only)
  • Have a face-to-face visit with their treating provider documenting insulin use and CGM necessity

Coverage includes the CGM receiver, transmitters, and sensors. Patient cost share: typically 20% of the Medicare-approved amount after the deductible.

Covered CGMs under Medicare Part B (as of 2026): Dexcom G7, FreeStyle Libre 3, Medtronic Guardian 4.

Medicaid Coverage

Medicaid CGM coverage varies by state. Most states cover CGMs for Type 1 diabetes on intensive insulin therapy. Type 2 coverage is less consistent — check your state’s Medicaid fee schedule or ask your endocrinologist’s office to verify coverage before prescribing.

Commercial Insurance

Most major commercial insurers (United, BCBS, Aetna, Cigna) cover CGMs for:

  • Type 1 diabetes: generally well covered with prior authorization
  • Type 2 on insulin: covered by most plans, may require prior auth
  • Type 2 on non-insulin medications: coverage is improving but inconsistent — a letter of medical necessity from your provider significantly helps approval

How to Get CGM Covered

  1. Ask your endocrinologist or primary care provider for a CGM prescription with a diagnosis code (E10.x for T1D, E11.x for T2D)
  2. The provider’s office submits a prior authorization — most approvals take 1-5 business days
  3. If denied: ask for a peer-to-peer review (your doctor speaks directly with the insurance medical director), which reverses denials significantly more often than appeals alone

Manufacturer Assistance Programs

  • Dexcom: Dexcom Access Program reduces cost for uninsured or underinsured patients
  • Abbott: FreeStyle Promise provides sensors for $75/month for eligible patients

OTC As a Backup

For Type 2 patients who cannot get insurance coverage, Dexcom Stelo and Abbott Lingo provide CGM functionality at ~$99/month without a prescription — less than a month’s supply of many name-brand diabetes medications.