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Covered. / CGM / California
California · Medicare DME Coverage

Does California Medicaid Cover a CGM?

Last verified May 1, 2026 · 3 sources cited

Yes — Medicare Part B covers a continuous glucose monitor (CGM) when you have diabetes and meet documented monitoring criteria. As of 2023, you no longer need to be on insulin if you have a documented history of problematic hypoglycemia.

Who qualifies

  • You have a diagnosis of diabetes (Type 1 or Type 2).
  • Your doctor has prescribed the CGM and documents the medical need.
  • You either use insulin OR have a documented history of problematic hypoglycemia.
  • You or your caregiver are trained to use the device and act on its readings.

Qualifying conditions

  • Type 1 diabetes
  • Type 2 diabetes on insulin
  • Type 2 diabetes with documented problematic hypoglycemia (CMS expanded criteria, effective April 2023)

What it costs

2026 Part B deductible
$240
Your coinsurance
20%
  • After meeting the Part B deductible, Medicare pays 80%; you pay the remaining 20% — unless you have a Medigap plan that covers it.
  • Most Medicare Advantage plans cover CGM at parity, but copay structures vary.
  • Supplies (sensors, transmitters) ship as a recurring DME benefit — usually monthly or quarterly.

Check if you qualify

Step 1 of 2

Takes about 60 seconds. We'll show you what your plan covers and connect you with a supplier if you qualify for CGM.

Prior authorization timeline

Typically 5–10 business days once your doctor submits the order and clinical documentation.

Frequently asked

Does Medicare cover a CGM if I'm not on insulin?

Yes, as of April 2023. CMS expanded coverage to include people with Type 2 diabetes who have a documented history of problematic hypoglycemia, even without insulin use. Your doctor must document at least two qualifying hypoglycemic events.

Which CGMs does Medicare cover?

Medicare covers therapeutic CGMs that meet FDA non-adjunctive use criteria — currently Dexcom G6/G7, FreeStyle Libre 2/3, and Eversense. Stelo and other over-the-counter CGMs are not currently Medicare-covered as of 2026.

How much does a CGM cost with Medicare?

After the 2026 Part B deductible ($240), you pay 20% coinsurance on the Medicare-approved amount. Out-of-pocket monthly cost typically runs $40–$80 depending on the device and your supplemental coverage.

Can I switch from FreeStyle Libre to Dexcom on Medicare?

Yes. Your doctor writes a new prescription for the device you want, and your DME supplier processes the switch. There is no waiting period, but you cannot bill both devices in the same supply month.

Does Medicaid cover CGM?

It varies by state. Many states cover CGM under Medicaid for Type 1 and insulin-dependent Type 2; non-insulin coverage is expanding but inconsistent. See our state-specific pages for current rules.

Sources

California Medicaid coverage

Covered

Medi-Cal covers therapeutic CGMs through the Medi-Cal Rx pharmacy carve-out (not the DME benefit), for insulin-dependent members or those with documented problematic hypoglycemia. PA is required and managed by Magellan/Medi-Cal Rx.

Prior authorization
Required
Form: Medi-Cal Rx Prior Authorization Request (via CoverMyMeds or Medi-Cal Rx portal)
Timeline
24 hours for urgent / up to 72 hours routine via Medi-Cal Rx

Who qualifies in California

  • Diagnosed diabetes requiring insulin OR documented problematic hypoglycemia
  • Device must appear on the Medi-Cal Rx Contracted CGM List (Dexcom G7, Libre 3 Plus, etc.)
  • Prescriber must be enrolled in Medi-Cal

Supplier requirements

CGM hardware and supplies billed through pharmacy benefit (Medi-Cal Rx / Magellan), NOT DME suppliers. Pharmacy must be enrolled with Medi-Cal Rx.

Managed care

CGMs are CARVED OUT of Medi-Cal Managed Care plans (Anthem, Health Net, LA Care, etc.) and adjudicated by Medi-Cal Rx fee-for-service for ALL members. MCO has no say.

Common gotchas (most reference sites miss these)

  • Medi-Cal Rx pharmacy carve-out — most reference sites still describe this as a DME benefit; it is not
  • Type 2 non-insulin members were moved from MCP medical benefit to Medi-Cal Rx in Feb 2024 — old PAs may not transfer cleanly
  • Only devices on the Contracted CGM List are covered

Sources for California