Mastering CGM insurance: Tips for Diabetes Coverage

Getting insurance approval for a continuous glucose monitor (CGM) can be tricky—and pricey. Even with coverage, out-of-pocket costs can add up quickly. But CGMs are worth it! They help people with diabetes lower A1Cs, reduce risks of low blood sugar, and improve their quality of life.

Here’s a guide to navigating the hurdles of accessing a CGM, whether you’re insured, uninsured, or somewhere in between.

Getting a CGM through insurance

To start, check your insurance coverage details carefully. CGMs are usually covered under durable medical equipment (DME) benefits, not pharmacy benefits. This distinction matters because DME coverage often means you’ll pay 25–50% of the cost out of pocket.

Before hitting your deductible, you may need to pay for part or all of your CGM supplies. Once you meet it, your insurance will cover more—maybe even all—of the cost. At that point, you may just owe a copay until you meet your yearly out-of-pocket max.

Knowing your insurance benefits helps avoid surprises. Relay this info to your medical supplier to prevent unnecessary costs or billing headaches. Most DME suppliers can assist with this process, but being informed makes a big difference.

Tackling insurance hurdles

Sometimes, insurance requires “prior authorization” to prove a CGM is medically necessary. This can feel daunting, but your doctor can help. Many patients need prior approval before insurance covers their CGM.

Tips for overcoming insurance obstacles:

• Call your insurance and ask what’s required to approve your CGM.
• Have your doctor submit statements proving your medical need, like recurring severe or nocturnal hypoglycemia or blood sugar fluctuations.
• Document two weeks of blood sugar levels in a spreadsheet to highlight highs and lows.
• Work with your certified diabetes care and education specialist (CDCES) or endocrinologist to streamline approval. Their expertise can prevent denials.
• Research costs—sometimes it’s cheaper to pay out of pocket than go through insurance. Compare CGM options to find the best fit for your budget.
• Don’t give up! Persistence pays off when demonstrating why a CGM is essential for managing your diabetes.

CGMs are an incredible tool for improving diabetes care. If it doesn’t work out, you can always return to using a blood glucose meter (BGM) alone.

Accessing a CGM without insurance

For those without insurance, don’t lose hope. While older CGM models may not be ideal, they’re still better than having none at all. Keeping an open mind and exploring different avenues can make CGM technology more accessible.

Ways to save on CGM supplies:

• Look for discounts through sources like Save Rite, Lifeline Direct, and Diabetic Warehouse.
• Explore assistance programs from organizations like BlinkHealth, RX Hope, RX Outreach, and the CR3 Diabetes Association.
• Request CGM samples from your doctor—they often have extras to share!

Additional discount programs

Other programs might help if you qualify:

• Dexcom and Freestyle Libre Patient Assistance Programs: Available for insured individuals who meet eligibility requirements.
• Free trial programs: Companies like Dexcom (Hello, Dexcom) and Freestyle Libre (My Freestyle) offer short-term trials
• Medicare or Medicaid: Some states cover CGMs through these plans. Advocacy efforts are working to improve coverage across the U.S.
• Look for discounted CGM supplies at sources like: 

• • Save Rite
  • Lifeline Direct
  • Diabetic Warehouse

• Talk to your doctor
  • Ask your doctor for CGM samples! They want to help.

The bottom line

Managing diabetes can be expensive, but you shouldn’t have to go without the supplies you need to thrive. If you’re struggling, take advantage of the tips and programs here to access a CGM. Whether it’s through insurance or other means, a CGM might be the next big step in your diabetes care journey. Remember: persistence is key!

Regardless of insurance, diabetes supplies and medications can be expensive. No one should have to go without the medications and supplies they need to survive. If you are struggling to afford the supplies and medications you need to manage your diabetes successfully, use these other guides as support:

• • Health Insurance Hurdles 101: Insulin + Diabetes Supplies
  • All About Insurance + Type 1 Diabetes

This content was made possible by Dexcom, an active partner of Beyond Type 1. Beyond Type 1 maintains editorial control over its content.