Will Your New Health Insurance Plan Cover CGMs?

2026 is right around the corner. That means it’s time to start thinking about insurance coverage and whether or not your continuous glucose monitor (CGM) will be covered. 

CGMs are powerful tools in diabetes management. They provide real-time blood glucose readings so you can more easily prevent or respond to high or low blood sugar. 

Unfortunately, CGMs aren’t always covered the same by health insurance from year to year. Costs can also change from year to year depending on the insurance provider and plan. 

Continue reading to learn more about questions to ask insurance companies, the typical costs of CGMs and ways to save money. 

Questions to Ask Your Insurance Provider

It’s a good idea to be prepared and ask questions about your insurance coverage. 

Keep these questions in mind:

• Are CGMs covered under Pharmacy or Durable Medical Equipment (DME) benefits?
• Do you cover (or not cover) specific CGM brands, such as FreeStyle Libre or Dexcom?
• Do I need to use a preferred supplier or pharmacy?
• What will my copay be after meeting my deductible? 
• What is the estimated cost before meeting my deductible?
• Is a prior authorization required for CGMs, and how often does it need to be renewed? 

You may need to work with your healthcare provider to submit a prescription for your preferred CGM system to see what coverage looks like for your specific healthcare plan. 

Out-of-Pocket Costs for CGMs

The cost of CGMs vary. With insurance coverage, factors like insurance formularies, deductible status and in-network suppliers all play a role. 

The out of pocket price of CGMs can be hundreds of dollars per month without insurance. However, there are coupons and programs available to help decrease the cost.

The FreeStyle Libre 3 Plus is said to be more affordable than other CGMs on the market. While the company offers a free trial to qualifying first-time patients, Abbott does offer a copay savings card for continued use as well. 

Other savings outlets include GoodRx, SingleCare and WellRx. 

What to do Before Coverage Resets in January

Check for preauthorization requirements that will expire at the start of the new year and request new ones from your healthcare provider (HCP) as soon as possible to get ahead of the rush.

At the beginning of each year, deductible resets occur. This means your annual deductible amount starts over, which may change the out-of-pocket cost of your prescriptions until you meet your deductible again. 

To reduce the burden of coverage changes in January, plan ahead in December. Order refills of your medications and supplies at the end of the year—in 90-day quantities if possible—to help stretch the amount of supplies you have on hand into the new year.  

Finally, review your new plan and verify if coverage or suppliers will change under the new formulary. 

Cost-Saving Tips & Tricks

In addition to manufacturer savings programs like the one Abbott provides, there are other ways to save money. 

Ask your HCP for samples. If you have a flexible spending account (FSA) or health savings account (HSA), you can use those funds to help pay for CGMs. 

Also, consider switching DME suppliers. If you can choose between a Pharmacy or DME company to fill your CGM prescription, the Pharmacy benefits route is often cheaper and simpler. 

Key Takeaways

It’s time to get prepared for insurance coverage changes and resets coming in January. Remember to:

• Request 90-day refills of your medications and supplies before the end of December.
• Check with your insurance provider about coverage for your CGMs—and if you are able to fill your prescription through your pharmacy benefits to potentially lower your out of pocket costs. 
• Make sure you know what your insurance deductible dollar amount is so you know what to plan for in start-of-the-year costs. 
• Talk to your healthcare provider about any concerns you have with the CGM you are using, including how costs may be impacting your ability to get them.

Planning ahead can help prevent any gaps in access to the tools you need to be well!

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