What Does Continuous Glucose Monitoring Really Cost – And How Does Insurance Help?

If you’ve ever tried to figure out how much a continuous glucose monitor (CGM) actually costs—and what your insurance will or will not pay—you know it can feel confusing fast. There are sensors, transmitters, receivers, apps, deductibles, prior authorizations, and different rules for private insurance, Medicare, and Medicaid.

This guide breaks all of that down in clear, simple language. You’ll learn:

• What CGMs are and what you pay for over time
• How insurance plans typically approach CGM coverage
• Where out-of-pocket costs usually come from
• Practical steps to check your own coverage and avoid surprises

Throughout, the focus is on costs, coverage, and informed decision-making, not medical advice or product promotion.

Understanding the Basics: What You’re Paying For With a CGM

Before looking at insurance, it helps to know what makes up the total cost of continuous glucose monitoring.

What is a CGM, in cost terms?

A continuous glucose monitor usually includes:

• Sensor – a small piece placed under the skin that measures glucose in the fluid between cells. It needs to be replaced regularly (for example, every week or every couple of weeks, depending on the system).
• Transmitter – sends glucose data from the sensor to a receiver or smartphone. Some systems have a reusable transmitter that lasts several months; others build this function into each disposable sensor.
• Receiver or compatible device – a separate handheld device, insulin pump, or smartphone app that displays glucose readings.

💡 Key idea: Even if the device itself seems affordable, CGMs are ongoing expenses, not one-time purchases. The main recurring cost is usually sensors (and sometimes transmitters).

Types of costs to think about

When people talk about “CGM costs,” they’re often mixing several things together:

1. Upfront costs

   • Initial starter kit
   • Receiver or dedicated reader (if needed)
   • First sensors and transmitter

2. Recurring monthly or yearly costs

   • Replacement sensors
   • Replacement transmitters (if separate)
   • Possible upgrades or replacement receivers over time

3. Service and support factors

   • Pharmacy vs. durable medical equipment (DME) billing
   • Shipping or handling fees for mail-order supplies
   • Occasional tech-support replacements that might be free or discounted, depending on circumstances

Insurance coverage can affect all three categories—but not always in the same way.

How Much Does a CGM Cost Without Insurance?

Exact prices vary by brand, region, and pharmacy or supplier, so any specific number can change. However, the pattern is fairly consistent:

• Sensors are the main ongoing cost
• Transmitters and receivers are secondary but can still be significant
• Out-of-pocket costs are much higher without insurance than with coverage, especially over months or years

People paying completely out of pocket often focus on:

• How long each sensor lasts
• Whether a separate transmitter is needed
• Whether they can use a smartphone instead of buying a receiver

Some individuals look for pharmacy discount programs, manufacturer coupons, or cash-pay options to reduce cost when insurance coverage is limited. These programs can sometimes help, but they may have eligibility requirements, time limits, or other conditions.

💡 Big picture: Without insurance, CGM costs can add up quickly over the course of a year. That’s why understanding your insurance options is so important.

How Health Insurance Typically Covers CGMs

Coverage for continuous glucose monitoring is improving in many places, especially for people with diabetes who use insulin. At the same time, every plan sets its own rules, so real-world coverage can range from very generous to quite limited.

Let’s look at the most common kinds of coverage in broad terms.

Private insurance (employer plans, individual plans)

Private health plans often cover CGMs, especially for people with certain forms of diabetes who use insulin. But coverage can depend on:

• Type of diabetes
• Frequency of insulin use (for example, multiple daily injections or an insulin pump)
• History of low blood sugar or other complications
• Whether a doctor documents why a CGM is needed

Some plans cover CGMs as:

• Durable medical equipment (DME) – billed through a medical supplier, with coverage sometimes tied to a percentage coinsurance (for example, a fraction of the allowed charge after deductible).
• Pharmacy benefit – obtained at a local or mail-order pharmacy, often with a copay or coinsurance similar to medications.

The same CGM system may cost very different amounts to you depending on how your plan chooses to categorize it.

Medicare and CGMs

Medicare in many countries has specific rules for covering CGMs. In some regions:

• Coverage is often available for people with certain forms of diabetes who use insulin
• There may be requirements relating to insulin dosing frequency
• Some systems may be covered as therapeutic CGMs, meaning they can be used to adjust insulin dosing

People on Medicare commonly encounter:

• Deductibles – a set amount you must pay before coverage kicks in
• Coinsurance – a percentage of the allowed amount that you continue paying, even after the deductible
• Possible supplier limitations – you may need to use specific approved vendors

Because Medicare policies can change and may differ by local region or plan type, it’s essential for patients or caregivers to check directly with their plan or a plan representative.

Medicaid and CGMs

Medicaid programs are run at a state or regional level, so coverage varies widely. In some areas:

• CGMs may be covered for certain individuals who meet medical criteria
• Prior authorization is common
• There may be differences between traditional Medicaid and managed-care Medicaid plans

Coverage rules can include:

• Specific forms of diabetes
• Age-related criteria
• Documentation of difficulties with traditional fingerstick testing

Anyone relying on Medicaid usually needs to work closely with their care team and their plan to understand access and cost.

Common Insurance Terms That Affect CGM Costs

Even when a plan “covers” continuous glucose monitoring, the amount you pay depends on how coverage is structured. Some of the most important terms:

• Deductible – The amount you pay out of pocket each year before your insurance starts paying for many services. CGMs may or may not be subject to the deductible, depending on your plan.
• Copay – A fixed amount you pay each time you fill a CGM prescription or receive supplies, such as a flat cost per sensor pack.
• Coinsurance – A percentage of the cost that you’re responsible for (for example, a portion of the allowed charge for a CGM sensor).
• Out-of-pocket maximum – The total amount you could pay in one year for covered services, after which the plan typically covers eligible costs at 100%, at least for that year.
• Prior authorization – Approval your insurance may require before it agrees to cover CGM devices or supplies.

Understanding these concepts helps you estimate how much CGM coverage will cost you throughout the year, not just on the first fill.

What Determines Whether Your Insurance Covers a CGM?

Insurance plans often use clinical criteria and documentation to decide if they will pay for a CGM. These criteria might include:

Diagnosis and treatment pattern

Plans commonly look at:

• Whether the person has a recognized form of diabetes
• Whether they use insulin, and how often
• Whether they are using multiple daily injections or an insulin pump

Some plans are more open to CGM for people who are not on insulin; others reserve coverage mainly for those on intensive insulin regimens.

Health risk and safety considerations

Plans may consider:

• History of low blood sugar (hypoglycemia) episodes
• Lack of awareness of low blood sugar
• Frequent blood sugar variability
• Challenges managing glucose with traditional fingerstick methods

For many insurers, documented safety concerns make CGM coverage more likely.

Evidence of ongoing follow-up

Plans sometimes require:

• A prescription from a health professional
• Evidence of regular follow-up appointments
• Notes describing how CGM data will be used in day-to-day management

These requirements are often framed around ensuring that CGMs are used as part of a broader care plan, rather than as stand-alone devices.

Typical Out-of-Pocket Costs With Insurance

Even when insurance “covers” CGMs, many people still pay something out of pocket.

Here’s a simple framework to think about potential costs over a year:

💡 Tip: Many people see their highest out-of-pocket CGM costs early in the benefit year, when the deductible applies, and lower monthly costs later on once the deductible and part of the out-of-pocket maximum are met.

CGM Coverage Through Pharmacy vs. DME: Why It Matters

One subtle but important factor is whether your plan treats CGMs as a pharmacy benefit or durable medical equipment (DME).

CGM as a pharmacy benefit

When CGMs are billed through the pharmacy benefit:

• You get sensors and transmitters through a retail or mail-order pharmacy.
• Your cost may look similar to a medication copay or coinsurance.
• You might have more transparent pricing at the pharmacy counter.

Many people find pharmacy-based coverage more predictable and convenient, but it depends on their specific plan’s copay structure.

CGM as durable medical equipment (DME)

When CGMs fall under DME:

• They are often supplied by a medical equipment company rather than a local pharmacy.
• Costs may be subject to coinsurance (a percentage of the allowed amount), sometimes after a deductible.
• There may be more paperwork, and prior authorization is common.

In some plans, DME coverage is generous; in others, it can be limited. The same CGM could be relatively affordable on one plan and much more expensive on another, largely because of this distinction.

Practical Steps to Check Your CGM Coverage

Because coverage varies so widely, the most reliable way to understand your CGM costs is to ask targeted questions.

1. Contact your insurance plan

When calling the number on your insurance card, it can help to ask:

• “Is continuous glucose monitoring covered under my plan?”
• “Is it covered under my pharmacy benefit, my medical/DME benefit, or both?”
• “What are the typical out-of-pocket costs (copays or coinsurance) for CGM sensors and transmitters?”
• “Do I need prior authorization? If so, what documentation is required?”
• “Are there specific brands or suppliers I must use?”

Writing down the date, time, and representative’s name can help you keep track of what you were told.

2. Ask about deductibles and maximums

To get a fuller picture of yearly costs, you might ask:

• “Does my deductible apply to CGM supplies?”
• “What is my annual out-of-pocket maximum, and how do CGM expenses count toward it?”

This can give you a sense of how your costs may change over the year.

3. Involve your healthcare team

Healthcare professionals who regularly work with people with diabetes are often familiar with:

• Common insurance criteria for CGM coverage
• Typical documentation requirements
• How to submit prescriptions and supporting information

They may help by providing the detailed notes and forms that insurers often request, such as:

• Documenting the diagnosis and treatment regimen
• Noting any hypoglycemia episodes or high variability
• Explaining why CGM is being requested

Strategies People Use to Manage CGM Costs

While every situation is different, there are common strategies people use to keep costs manageable.

Choosing between smartphone and receiver

Some CGM systems allow use of:

• Smartphone apps to display readings, or
• Dedicated receivers

Where this is an option, some individuals avoid buying a separate receiver and rely on their phone instead, which can reduce upfront cost. Others prefer or require a dedicated receiver for reasons like phone compatibility, preference, or plan requirements.

Timing refills and benefits

Some people try to:

• Schedule refills after their deductibles are met, when possible
• Keep a small cushion of sensors on hand, within allowed limits, to avoid interruptions from shipping delays or prior authorization renewals

This kind of planning can help avoid unexpected gaps in access.

Exploring manufacturer assistance

Many CGM manufacturers have:

• Patient assistance programs for people with limited income or no insurance
• Introductory or trial programs that reduce cost for the first month or two
• Occasional copay savings programs with eligibility rules

These programs are not guaranteed and may be time-limited, but for some patients they can help bridge financial gaps.

Quick-Reference: Key Questions to Ask About CGM Costs

Here’s a skimmable checklist you can use when speaking with your insurance or supplier. ✅

🧾 Insurance & Coverage

• Do you cover continuous glucose monitors (CGMs) under my plan?
• Are they billed under pharmacy or DME/medical benefits?
• Is there a preferred brand or model that has better coverage?
• Do I need a prior authorization or special form from my doctor?

💵 Out-of-Pocket Costs

• What will I pay for:
  • Starter kit?
  • Sensors?
  • Transmitters?
  • Receiver, if needed?
• Are costs based on copay or coinsurance?
• Is my deductible already met this year?
• How do CGM costs count toward my out-of-pocket maximum?

📦 Suppliers & Refills

• Which pharmacies or DME suppliers are in network for CGMs?
• How often can I refill sensors?
• Are there limits on how many supplies I can get at once?

Keeping these questions handy can make your insurance calls shorter and more productive.

Special Considerations for Different Life Situations

CGM coverage and costs can become more complicated during times of change. Here are a few examples where it might help to plan ahead.

Changing jobs or health plans

When switching employers or plans, there may be:

• A waiting period before new coverage starts
• Differences in which CGMs are preferred or covered
• Changes in deductible and out-of-pocket structures

Some people try to:

• Refill sensors before an old plan ends, if allowed
• Confirm coverage for their CGM system under the new plan
• Ask whether they can get an exception if their current CGM is not on the new plan’s preferred list

Aging into Medicare

People moving from employer coverage to Medicare often need to:

• Learn the difference between Medicare Parts A, B, D, and Medicare Advantage plans
• Understand how each option approaches CGM coverage
• Confirm which suppliers and systems are approved under their chosen plan

The transition period is often a good time to call both the current and upcoming plans to avoid surprises.

Traveling or living between locations

For those who travel frequently or spend time in different states or countries:

• Coverage for CGM supplies may depend on network pharmacies or suppliers
• Shipping or refill policies may differ based on location

Some individuals try to arrange refills before long trips or confirm with their plan whether they can pick up sensors in another region.

Balancing Benefits, Costs, and Practical Realities

Beyond pure dollars and cents, people often weigh CGM costs against:

• The amount of information they get from continuous readings
• How much the data helps them understand patterns in their glucose
• Practical aspects like alarms, convenience, and reduced fingerstick testing

From a cost perspective alone, important considerations include:

• Total yearly expense, not just first-month cost
• How often sensors and transmitters need to be replaced
• How insurance might change over time

Insurance policies and coverage guidelines continue to evolve. As more people use CGMs, many plans are gradually expanding coverage criteria—but details still vary widely.

At-a-Glance: Key Takeaways on CGM Costs & Coverage

Here’s a condensed snapshot of the most important points. 📌

• CGMs are ongoing expenses, mainly due to recurring sensors and, in some systems, transmitters.
• Insurance coverage is common but not universal, and criteria differ by plan, diagnosis, and insulin use.
• Out-of-pocket costs depend heavily on whether your plan applies deductibles, copays, or coinsurance to CGMs.
• Pharmacy vs. DME billing can greatly change what you pay and how you get supplies.
• Prior authorization and documentation from healthcare professionals are frequently required.
• Manufacturer programs and assistance may reduce costs for some people, especially with limited coverage.
• Checking coverage directly with your plan—using specific, targeted questions—is the most reliable way to understand your own costs.

Bringing It All Together

Continuous glucose monitoring can be a powerful tool for tracking glucose trends, but it also introduces specialized and recurring costs. The true price of a CGM is not just the sticker cost of a sensor; it is a combination of ongoing supplies, insurance rules, deductibles, and benefit designs.

By understanding:

• What you’re actually paying for (sensors, transmitters, receivers)
• How your insurance classifies and covers CGMs
• Which questions to ask and which details to track

you can move from uncertainty to a clearer, more confident picture of what continuous glucose monitoring will cost in your specific situation.

This knowledge does not replace professional medical or financial guidance, but it can make you a more informed participant in conversations with your healthcare team, insurer, and supplier—so that any choices around CGMs are based on transparent information rather than surprises at the pharmacy counter.