Medicare Coverage for FreeStyle Libre: Details on Tests, Devices, and Related Aspects
Medicare, the healthcare programme for Americans aged 65 and above, offers coverage for various diabetes-related equipment and treatments. One such device is the FreeStyle Libre, a continuous glucose monitoring (CGM) system that allows users to check their blood sugar levels in real time without pricking their fingers [1].
Under Medicare Part B, the FreeStyle Libre is considered durable medical equipment (DME). To qualify for coverage, the CGM must be FDA-approved, and you need a prescription from a Medicare-approved healthcare provider who also monitors your CGM use regularly. Medicare requires an in-person or telehealth visit within six months before ordering the CGM but no longer requires routine finger-stick blood glucose testing [1][3].
If a person has a Medicare supplement insurance plan (Medigap), the plan may help cover their out-of-pocket costs for FreeStyle Libre [1]. Medicare Part B typically requires a 20% coinsurance for DME, including CGMs, after you meet the Part B deductible. You might also have to pay the deductible upfront. Some Medicare Advantage plans may have different cost-sharing or copayments [2][3].
It's essential to note that Medicare Part D generally covers the costs of insulin that a person administers as a result of their FreeStyle Libre readings. However, Part D does not cover the CGM itself. For full coverage of all diabetes supplies including insulin and testing supplies, combining Part B coverage with a Part D drug plan or a Medicare Advantage plan is often necessary [3].
Medicare also covers some types of insulin pumps, which can monitor and administer insulin. For those who need financial assistance, Medicaid provides help for people who need help paying the Part B copay for the FreeStyle Libre. Out-of-pocket costs for the FreeStyle Libre may still apply, and programs such as Extra Help may cover some of these costs [1].
In summary, users should expect a possible deductible and coinsurance with Original Medicare Part B, while Medicare Advantage plans may offer different cost structures that could reduce out-of-pocket expenses [1][3][4]. Here is a summary of Medicare coverage for CGMs like FreeStyle Libre and Dexcom G6/G7:
| Medicare Part | Coverage Details | Additional Costs | |---------------|------------------------------------------------------|---------------------------------------| | Part B | Covers FDA-approved CGMs as durable medical equipment if prescribed and monitored | 20% coinsurance after Part B deductible; deductible applies | | Part C (Advantage) | Similar coverage to Part B, may vary by plan | Copayments/coinsurance vary by plan | | Part D | Covers insulin and administration supplies, not CGMs | Copayments and deductibles vary |
For those living with Type 2 diabetes, managing blood sugar levels can be challenging. The FreeStyle Libre offers a convenient solution, allowing users to monitor their blood sugar levels continuously without frequent finger pricks [1]. Speak with your healthcare professional about what monitoring approach may be best for you.
[1] Medicare.gov. (2021). Continuous Glucose Monitoring Systems (CGMs) and Insulin Pumps. Retrieved from https://www.medicare.gov/Pubs/pdf/11060-Continuous-Glucose-Monitoring-Systems-and-Insulin-Pumps.pdf
[2] Medicare Rights Center. (2021). Understanding Medicare Costs. Retrieved from https://www.medicareinteractive.org/get-answers/medicare-costs/
[3] National Diabetes Education Program. (2021). Continuous Glucose Monitoring Systems (CGMs) and Medicare. Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/managing-diabetes/understanding-insulin/continuous-glucose-monitoring-systems-cgms
[4] Medicare Rights Center. (2021). Medicare Advantage (Part C). Retrieved from https://www.medicareinteractive.org/get-answers/medicare-advantage-part-c/
- The FreeStyle Libre, a continuous glucose monitoring (CGM) system, is covered under Medicare Part B for those aged 65 and above.
- Medicare considers the FreeStyle Libre as durable medical equipment (DME) under Medicare Part B.
- To qualify for Medicare coverage, the CGM must be FDA-approved and a prescription is required from a Medicare-approved healthcare provider.
- Regular monitoring of CGM use is mandatory by a Medicare-approved healthcare provider.
- An in-person or telehealth visit is required within six months before ordering the CGM.
- Routine finger-stick blood glucose testing is no longer required by Medicare.
- Medicare supplement insurance plans (Medigap) may help cover out-of-pocket costs for the FreeStyle Libre.
- Medicare Part B typically requires a 20% coinsurance for DME after meeting the Part B deductible.
- Some Medicare Advantage plans may have different cost-sharing or copayments for the FreeStyle Libre.
- Medicare Part D generally covers the costs of insulin, but does not cover the CGM itself.
- For full coverage of diabetes supplies, combining Part B coverage with a Part D drug plan or a Medicare Advantage plan is often necessary.
- Medicaid provides help for people who need financial assistance with the FreeStyle Libre's out-of-pocket costs.
- For those living with Type 2 diabetes, managing blood sugar levels can be challenging but the FreeStyle Libre offers a convenient solution.
- Speak with your healthcare professional about what monitoring approach may be best for managing diabetes and blood sugar levels.
