Looking to find out if you’re covered for a CGM? You’re in the right place.
We’re here to make it as easy as possible for you and your family to determine how you can get access to a CGM. So let’s get pumped about insurance!
The world is changing and CGM access is increasing every single day! It’s pretty exciting—and we expect this access to only continue to grow. CGMs are covered by most private insurance. They’re also covered under Medicare for ANYONE who takes insulin or has had repeated blood sugars under 54.
While 44 states have some coverage for CGM under Medicaid, there are a series of eligibility criteria that limit access. Almost all states require at least a diagnosis of diabetes, regular visits with your healthcare provider, and self-monitoring of blood glucose three times per day. Eligibility depends on the state, as some states have more limiting eligibility criteria.
Here are a few examples of these criteria that might impact whether Medicaid will cover your CGM:
- An A1C higher than 7 or 8 percent
- Frequent experiences with severe low blood sugar (54 or below)
- Multiple daily injections of insulin
- CGM prescribed by an endocrinologist or PCP
If you have private insurance, your best option is to talk to them or your healthcare team to see what CGMs are available for you under your current plan.
The ADA’s latest standards of care for diabetes, essentially the U.S.’s guide to how diabetes should be cared for, mention time in range—which is a huge deal. That means that the country’s experts on diabetes believe time in range is a quintessential part of diabetes care, and we agree.
Policies may change, but we will always have the latest information here for you! Let us be your one-stop shop for everything you need to know about accessing time in range and taking the next steps in your healthcare journey.
You can learn about whether you’re covered for CGM use by reading more here:
CGM and Medicaid: Who’s Covered? (state-by-state information)