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Florida · Medicare DME Coverage

Does Florida 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

Florida Medicaid coverage

Covered

Florida Medicaid covers CGMs as a pharmacy benefit (effective Oct 2024). 2025 legislation (HB 1465 / SB 1182) directs AHCA to seek federal approval to ALSO restore DME-channel coverage, but as of May 2026 pharmacy is the primary channel.

Prior authorization
Varies
Form: Plan-specific (pharmacy PA via MCO)
Timeline
MCO standard pharmacy PA (typically 24-72 hours)

Who qualifies in Florida

  • Diagnosis of diabetes mellitus
  • Insulin-dependent or documented problematic hypoglycemia
  • Prescriber-documented medical necessity

Supplier requirements

Run through pharmacy benefit, not DME supplier; DME billing was carved out in 2023 and is only being reconsidered via 2025 legislation.

Managed care

Nearly all FL Medicaid recipients are in SMMC MMA plans (Sunshine, Humana, Simply, Aetna Better Health, etc.). Each plan administers the pharmacy benefit through its PBM with its own preferred CGM (Dexcom vs Libre).

Common gotchas (most reference sites miss these)

  • DME suppliers cannot bill FL Medicaid for CGMs as of 2024
  • Preferred brand varies by MCO PBM
  • 2025 HB 1465/SB 1182 may restore dual DME+pharmacy coverage but had not taken effect at time of writing