Getting a CGM for Type 2 Diabetes on Medicare
The benefits of using a continuous glucose monitor (CGM) as a person with any type of diabetes are significant and well-known. For people with type 2, however, getting a prescription and insurance coverage for a CGM can be an unfair challenge.
If you have type 2 diabetes (T2D) and you’re on Medicare, those challenges essentially become solid roadblocks. Despite significant progress in the Medicare coverage for CGMs in diabetes care, the existing rules still prevent millions from using this technology to help them thrive with diabetes.
Here, we’ll look at who qualifies for a CGM if you’re on Medicare with type 2 diabetes.
Why do people with type 2 diabetes need a CGM?
The more blood sugar data you have, the more you can live safely day-to-day with diabetes and prevent the development or progression of diabetes complications.
While A1c testing offers a glimpse into how your blood sugars have been doing over the course of the previous three months, it can’t help you in your day-to-day, hour-by-hour diabetes management.
An A1c result cannot tell you what times of day your blood sugars are frequently high or frequently low to help you make adjustments in your regimen and medications—with support from your healthcare team.
Blood sugar checks using test-strips, a meter and a finger-prick are also lacking because it doesn’t tell you the direction of your blood sugar. Like an A1c result, it also cannot alert you to rising or falling levels while you are sleeping, walking your dog, or while you are driving.
A CGM, on the other hand, can tell you:
- Real-time blood sugar levels every five minutes
- Your average blood sugar
- Your time-in-range, above range, below range
- If you blood sugar is rapidly falling or rising
- If you fall low while you are asleep otherwise occupied
- When and how often you are high or low
- …and share this data in real-time with a family member
- …and share this data in reports with your healthcare team
A CGM is simply today’s standard of care for the most informed—and safest—life with any type of diabetes. As diabetes technology has evolved, access to that technology ought to evolve, too, making it accessible to anyone living with any type of diabetes.
Who qualifies for a CGM on Medicare?
“If you’ve been diagnosed with type 2 diabetes and you’re on an ‘intensive insulin regimen,’ you meet the criteria for CGM reimbursement,” explains Christel Marchand Aprigliano, chief advocacy officer at Beyond Type 1.
To qualify for a CGM on Medicare as a type 2, you must (as of Dec. 2020):
- Have an official diagnosis of type 2 diabetes
- Be on an “intensive insulin regimen” of both basal and bolus insulin
- Have appointments with the prescriber/healthcare professional who treats you for your diabetes every six months (at minimum)
- Submit reports every six months to review blood sugar levels
- Appointments must be “in person,” not “virtual”
“But an ‘intensive’ insulin regimen means you have to be taking both a basal (long-acting) and a bolus (mealtime) insulin. The current eligibility is administration of insulin at least three times daily,” adds Marchand Aprigliano.
In other words: simply taking daily injections of Lantus, Toujeo, Tresiba, Levemir, etc. does not qualify you for a CGM. Instead, you must also be taking a rapid-acting insulin for meals and correction doses.
This includes insulin taken via multiple daily injections with pens or syringes, a pump/patch pump, or inhaled insulin.
The only loophole to using CGM technology if you don’t qualify
“You can request a ‘professional CGM’ through your prescriber,” explains Marchand Aprigliano. “Your prescriber puts the sensor on you in the office, but it’s usually blinded—which means you can’t actually see your blood sugar data in real-time.”
Generally, you can wear a professional CGM for 7 to 14 days. Then your prescriber will download the data and review it to potentially make changes in your diabetes management regimen. Those changes might include putting you on an “intensive insulin regimen” which would then fully qualify you for a CGM and reimbursement through Medicare.
Looking back—and forwards—on CGM access for T2D
“Fortunately, you no longer need to prove that you check your blood sugar four times a day,” explains Marchand Aprigliano, who has been advocating for people with diabetes, access to care and technology and affordable insulin.
“This was a huge win for the diabetes community in the summer of 2021.”
It wasn’t until 2017 when CGMs were covered for those on Medicare at all.
“But then we immediately had to fight for coverage to use a smartphone to view your CGM readings,” explains Marchand Aprigliano.
In 2018, using a smartphone with your CGM was approved, explained DiabetesMine.
Marchand Aprigliano says in her work for Beyond Type 1, she and fellow advocates in the community are working arduously to make CGM technology accessible to people on Medicare regardless of their insulin or medication regimen. She’s also advocating for “virtual” appointments to satisfy requirements for interactions with your prescriber.
“All you should need to get a CGM is a diagnosis of diabetes—any type of diabetes,” says Marchand Aprigliano.
Educational content related to CGMs for type 2 diabetes is made possible with support from Dexcom. Beyond Type 2 maintains full editorial control of all content published on our platforms.