Continuous glucose monitors (CGMs) help people with Type 1 and Type 2 diabetes easily measure their blood glucose levels continuously throughout the day.
Newer CGM systems, such as the Freestyle Libre systems and the Dexcom G6, can help manage diabetes by allowing users to adjust insulin dosing without the need for fingersticks.*
But how much do these CGMs cost, and how much of that cost will your insurance cover?
In this post, we’ll answer all of your questions about the cost of CGMs and tell you how to find out if you can receive low-cost diabetes care supplies through your insurance.
What Will My Insurance Cover for a CGM?
It’s estimated that CGM products can cost up to $6,000 a year out-of-pocket!
That’s a high price to pay for necessary healthcare, especially when your Medicare or other private insurance plan may cover the cost of your CGM devices.
The products you can receive through Aeroflow Diabetes depend on what your specific insurance plan allows.
Currently, Aeroflow Diabetes offers two types of CGM systems that may be covered under the medical benefits of your insurance: Dexcom Continuous Glucose Monitoring Systems and Abbott Continuous Glucose Monitoring Systems. CGM systems typically consist of two basic components:
1. Reader: You get a reader when you initially start CGM therapy.
2. Sensors and Transmitter (Ongoing Supplies): Your sensors will be provided monthly or quarterly regardless of your system. The Dexcom G6 also has a transmitter, which is provided quarterly.
Typically, your CGM reader and supplies will be covered under the medical benefit of your insurance. This means what you owe will depend on your deductible and out-of-pocket limits. This can sometimes mean your insurance doesn’t pay anything towards your CGM reader and supplies (you pay the entire cost), and it can sometimes mean the insurance pays the entire amount (you pay no cost).
How this plays out is that you pay the full cost of your CGM supplies until your deductible is met. Once your deductible is met, you will be responsible for some portion of the cost (co-insurance) until your out-of-pocket limit is met. Let's walk through a few examples using a fictional Medicare patient to explain further.
Example Patient #1
John has never used CGM before. However, he has filled out the Aeroflow Diabetes qualify form and has been told he’s eligible to receive a CGM through his insurance.
John has a traditional Medicare plan no secondary insurance, and has already met his deductible. To get started on CGM, John will receive one CGM reader and one month’s supply of CGM sensors to start.
John’s specific Medicare plan will pay $384.20 (80% of the total cost) since he’s reached his deductible of $233, and he has no out-of-pocket limit. John will pay the remainder of $96.05 (20% of the total cost) for his initial supplies.
*This is an example, and rates and costs will be subject to change based on your individual insurance coverage and plan rates. Your deductible, co-insurance, and patient responsibility are also solely determined by your insurance plan.
Medicare Deductible: $233
Medicare Out-of-Pocket Limit: Medicare doesn’t have an out-of-pocket limit.
Co-insurance: 20%
Order Summary
- Continuous Glucose Monitoring System - Reader- Qty: 1
- Insurance Pays: $196.52
- What You Owe: $49.13
- Continuous Glucose Monitoring Sensors - Qty: 1 Month
- Insurance Pays: $187.68
- What You Owe: $46.92
Total Cost:
- Insurance Pays: $384.20
- What you Owe: $96.05
*Medicare requires that you receive a CGM reader regardless if you choose to use your cell phone or other smart device., This is a one-time requirement subject to standard Medicare DME equipment's reasonable useful life (RUL).
Example Patient #2
Sarah also has a traditional Medicare plan but is already using a CGM system. She is receiving an ongoing monthly supply of continuous glucose monitor sensors through Aeroflow Diabetes. Medicare allows suppliers to distribute 3 months’ worth of sensors at a time. However, Medicare billing requirements dictate that suppliers bill every month.
So, even though Sarah is getting a 3-month supply, the payment will be separated into 3 months. Each month, Sarah’s insurance will pay $187.68 (80% of the total cost) since she’s met her deductible. She’ll be paying the remainder of $46.92 (20% of the total cost) each month she has 30 days' worth of supplies in hand.
This is an example of how Medicare will cover the costs of a 3-month supply of CGM sensors, but your coverage and prices will be subject to change based on your insurance plan.
*This is an example, and rates and costs will be subject to change based on your individual insurance coverage and plan rates. Your deductible, co-insurance, and patient responsibility are also solely determined by your insurance plan.
Medicare Deductible: $233
Medicare Out-of-Pocket Limit: Medicare doesn’t have an out-of-pocket limit.
Co-insurance: 20%
Order Summary:
- Continuous Glucose Monitoring Sensors- Qty: 1 Month
- Insurance Pays: $187.68
- What You Owe: $46.92
How You Can Qualify for Low-Cost CGM Devices
If you have Medicare or other private insurance plans, you may be eligible to receive CGM supplies at little-to-no cost.
Follow these steps to see if you qualify.
Fill out the Aeroflow Diabetes Eligibility form. It’s fast and easy; just have your insurance card at hand.
Once you’re approved, our specialists will reach out to you to help you complete all the necessary paperwork required. We’ll also answer any questions you may have about insurance coverage or our CGM systems.
After choosing your supplies, they’ll be shipped directly to your home.
Insurance Coverage FAQs
How do I know if I have traditional Medicare or an Advantage plan?
You can check your coverage type by looking at your enrollment status. Enrollment status shows you the name of your plan, what kind of coverage you have, and the dates you’ll have coverage.
You can check your enrollment status online at www.mymedicare.gov or by calling 1-800-633-4227.
What happens to my costs if I have secondary insurance or supplemental coverage?
Some people have two insurance plans, called secondary insurance or supplemental coverage.
Secondary insurances or supplemental coverages come in various forms, and your coverage is adjusted based on these insurance plans. Some cover deductibles and co-insurance, leaving you with $0 in responsibility. Some secondary insurances only cover co-insurance, so you’re still responsible for your deductible. Other secondaries don’t apply to medical coverage or CGMs and only apply to specific types of claims, such as hospital stays or prescription drug coverage.
How do I know what CGM supplies are covered through my insurance policy?
Medicare covers the CGM reader and ongoing monthly supplies required for the reader's function. Most other insurance plans typically cover CGM similarly. Aeroflow Diabetes can provide you with the reader and an ongoing 30-day supply of CGM sensors and transmitters. To read more on what CGM supplies are covered, refer to the Medicare Coverage Database for CGMs.
Will my Medicare coverage change based on the state I live in?
No. Medicare coverage is nationwide, meaning you will be able to receive the same coverage for CGM devices based on your specific Medicare plan. However, the cost of your supplies and how Medicare covers them can.
Insurance Glossary
What Your Insurance Pays: Based on your deductible, out-of-pocket limit, and co-insurance, this is the estimated amount of money your health insurance provider will pay towards your CGM supplies. This amount can be $0 if your deductible is unmet.
What you Owe: Based on your deductible, out-of-pocket limit, and co-insurance, this is the estimated amount of money your health insurance provider requires you to pay out of your pocket. This amount can be more significant than $0 if your deductible is unmet or your deductible is met, and you are paying the co-insurance portion of the cost.
Your Deductible: A deductible is an amount you must pay out of your pocket before your health insurance provider will begin covering a predetermined percentage of your medical costs.
Out-of-Pocket Limit: Out-of-pocket limit is the maximum amount of money you will have to pay out of your pocket in a 1-year time frame. Once you’ve met your out-of-pocket limit, most health insurance providers cover any new medical costs at 100%.
Co-insurance: Co-insurance is the percentage or amount of money you must pay out of your pocket once your deductible has been met. Like a copay, co-insurance is the cost-share you are responsible for paying for covered services.
Information provided on the Aeroflow Diabetes website is not intended as a substitute for medical advice or care from a healthcare professional. Aeroflow recommends consulting your healthcare provider if you are experiencing medical issues relating to diabetes care.
* Fingersticks are required if your glucose alarms and readings do not match symptoms or when you see Check Blood Glucose symbol during the first 12 hours.