Medicare Coverage for the Freestyle Libre Glucose Monitor

Is the Freestyle Libre covered by Medicare?

The Freestyle Libre is one brand of CGM technology that is covered in some cases by Medicare.

CGMs have been covered by Medicare for some time under Medicare Part B.

Part B is the section of Medicare that covers outpatient care and some home medical equipment. As far as CGMs go, they fall under the Part B coverage for durable medical equipment (DME).

If you want to use a CGM instead of a more traditional blood sugar monitor, these devices will be covered. Using a CGM to monitor your blood sugar instead of a traditional monitor should be a shared decision between you and your doctor.

CGMs offer blood sugar monitoring that may be easier and more accurate than traditional methods.

The Freestyle Libre is a particular brand of CGM that has been approved by the FDA. Shortly after its approval, Medicare chose to extend coverage to the device.

For coverage of the Freestyle Libre under Part B’s DME rules, you must:

• Pay your monthly Part B premium.
• Meet your annual Part B deductible.
• Have a doctor’s order for the device from a physician who participates in Medicare.
• Meet specific criteria for device coverage.
• Order the device from a supplier that participates in Medicare.
• Pay your share of the device cost approved by Medicare.

If you have a Medicare Advantage (Part C) plan, coverage will at least match what’s offered under Medicare Part B.

Medicare Advantage plans are private insurance products that combine the coverage of Original Medicare with additional services at an additional cost.

Costs and services, as well as where you can receive care or order supplies, vary among different Medicare Advantage plans.

What equipment and accessories are covered?

Basic Medicare coverage of the Freestyle Libre includes everything you’ll need to operate and maintain the device.

This includes a patch with a thin sensor that goes under the skin to measure blood sugar and a reader that collects data from it. Abbott has also developed a smartphone app that works with the patches.

The patches worn with the Freestyle Libre system last 10-14 days. Medicare will cover the cost of refill items like additional patches.

Medicare will not cover a surplus of these supplies, though, and requires your supplier to contact you for specific needs about 2 weeks before the day you need the items shipped.

Automatic shipments of supplies for CGMs are not permitted by Medicare. The amount of supplies refilled has to match your individual anticipated future use and can’t be used to pay for supplies purchased in the past.

The Freestyle Libre device can be rented or purchased. There should be options for repair or replacement by your supplier if needed.

How do I qualify and get the motor?

While Medicare now covers all brands of CGMs, including the Freestyle Libre, there are some criteria you’ll have to meet, including:

• You must have a diagnosis of diabetes mellitus (type 2 diabetes).
• You must be already using a blood glucose monitor.
• You require blood glucose testing four or more times each day.
• You require insulin to keep your blood sugar within range.
• Your insulin treatment regimen needs frequent adjustments.
• You must have an in-person visit with the prescribing doctor

Beyond the initial criteria, you also have to meet ongoing requirements to ensure Medicare coverage:

• You must meet with the doctor who ordered your CGM every 6 months after your first prescription is written.
• Your doctor must certify that you meet the device’s criteria and ensure that you’re following your CGM regimen and diabetes treatment plan.

If you have Medicare Advantage, you may want to contact your plan before ordering a CGM to find out about any additional requirements or cost savings that might be available.

To get started with a CGM, like the Freestyle Libre, ask your doctor for a list of local suppliers that participate in Medicare. You can also use Medicare’s supplier finder tool.

Once you receive your Freestyle Libre, your doctor, and the supplier can help you learn how to use it properly.

What is the monthly cost of FreeStyle Libre?

According to a 2021 analysis of out-of-pocket costs, if you purchase the Freestyle Libre from a retailer—which would still require a prescription—you’d pay about $75 for the reader and $135 for the sensors.

With Medicare Part B coverage, you’d pay 20% of the Medicare-approved amount after your premium and deductible are met. Medicare would pay the remaining 80% of the cost.

With private insurance plans, like Medicare Advantage, people pay anywhere from $10-$75 per month for the Freestyle Libre sensors, according to the company.

Before ordering a CGM or additional supplies, check with your plan about specific costs and coverage so you’ll know what to expect to pay.

Can I get the FreeStyle Libre for free?

You may want to check for coupons and other savings programs from the manufacturer. In addition, some retailers, state healthcare organizations, or community groups may also offer financial assistance for diabetic supplies. You can search online to find ones in your area.

What other glucose monitors are covered by Medicare?

Medicare might cover other continuous glucose monitors approved by the FDA, such as the Dexcom G6 and Medtronic Guardian.

Generally, Medicare also covers fingerstick monitors and those specifically designed for individuals who are blind or have other disabilities. It also covers the implantable Eversense E3 system.

Besides glucose monitors, Medicare also covers many of the necessary costs of diabetes care, including supplies, medications, and appointments.

Learn more: Medicare and glucometers and Medicare and diabetic supplies.

Takeaway

Medicare covers most aspects of diabetes care. CGMs may be an option to help you simplify your diabetes care regimen, and Medicare covers CGMs like the Freestyle Libre.

That said, make sure you meet the criteria for coverage before renting or buying the equipment.