Does Medicare cover Freestyle Libre?

FreeStyle Libre is a continuous glucose monitor (CGM). It allows you to monitor your blood sugar constantly rather than intermittently.

You can apply the FreeStyle Libre sensor by yourself at home. There is a needle that pricks the skin when you first attach the sensor to your arm, but once the sensor is placed, you won’t have to worry about any finger pricks or needles for the next 14 days.

There are a few versions of the FreeStyle Libre created by Abbott on the market; there is the original FreeStyle Libre, the FreeStyle Libre 2, and the newest FreeStyle Libre 3, which are all flat circular sensors that apply to the arm. The latest FreeStyle Libre is the smallest of their glucose monitoring systems, which is around the size of two pennies stacked together. The previous models are around the size of two quarters stacked. 

Abbott’s FreeStyle Libre system works for both Type 1 and Type 2 diabetes. You do not need to be on insulin to use the FreeStyle Libre, as it’s a glucose monitoring option for all diabetics. However, as you’ll learn below, Medicare will only cover the device if you’re currently taking insulin.

You may notice that your blood sugar levels are different when using the FreeStyle Libre compared to a finger stick, but they both have around the same accuracy. This is because a finger stick calculates blood sugar glucose levels, while the FreeStyle Libre uses sensor glucose readings, which are taken from your interstitial fluid (ISF) rather than blood. ISF is fluid around the cells below the skin and above your bloodstream. However, FreeStyle Libre states it is still safe to calculate your insulin needs based on the sensor glucose reading.

Does Medicare cover FreeStyle Libre? 

“Medicare covers continuous glucose monitors, like FreeStyle Libre, under certain conditions,” explained Christina Valenzuela, a co-owner of Vista Mutual Insurance Services, an agency specializing in Medicare insurance. She went on to explain, “Medicare Part B and many Medicare Advantage Plans cover CGMs as Durable Medical Equipment (DME).“

Since FreeStyle Libre is considered DME, it is covered by Medicare Part B (outpatient medical insurance) rather than Medicare Part D (prescription drug insurance). 

How much does FreeStyle Libre cost with Medicare?

You will be responsible for 100% of the cost of FreeStyle Libre until you meet your Part B deductible. After you meet your deductible, Medicare will typically pay for 80% of the FreeStyle Libre, and you’ll pay 20% of the cost if you qualify for the device. If you have supplemental coverage, like a Medigap plan, an additional portion (or possibly all) of the 20% cost will be covered.

Medicare requirements for FreeStyle Libre

If you have Medicare or a Medicare Advantage plan, here is what you typically need for insurance to cover a CGM, like the FreeStyle Libre: 

• A physician will need to prescribe the equipment and determine that it is medically necessary. 
• The doctor and the supplier of FreeStyle Libre, like your pharmacy, must be enrolled with Medicare. 
• You must have diabetes and test your blood glucose levels four or more times each day. While you don’t have to be on insulin to use FreeStyle Libre, Medicare will only pay for it if you use insulin injections three or more times per day.
• Your healthcare provider will need to monitor the device at regular intervals. 

How to order FreeStyle Libre through Medicare

You’ll need to get a prescription from your healthcare provider for the FreeStyle Libre. If you qualify for coverage through Medicare, you’ll get the device at a pharmacy or medical equipment supplier that accepts Medicare. If you don’t have a location near you that offers the FreeStyle Libre, you can also order it through the mail. 

As each FreeStyle Libre lasts for 14 days, Medicare will pay for two CGMs every 28 days. You’ll get these refills the same way you got your original prescription for the device.

How much does FreeStyle Libre cost?

On average, one box of two FreeStyle Libre sensors costs $233 without insurance. Each FreeStyle Libre reader has an average cost of $104 without insurance. 

If you are eligible for Medicare coverage of FreeStyle Libre products under Part B, your cost will likely be 20% of the cash price. Using the average prices above, one box of two FreeStyle Libre sensors will be about $47 with Medicare, and one FreeStyle Libre reader will be about $21 with Medicare.

Other ways to save on FreeStyle Libre

If you don’t qualify for the FreeStyle Libre through your insurance plan, or you need more savings than Medicare coverage offers, there are a few options.

Medicare Savings Program

A Medicare Savings Program (MSP) is a good option offered by the state to help pay your Medicare Part A and Part B premiums. If you qualify, the MSP may also pay for your Part A and Part B deductibles, coinsurance, and copayments. 

Medicaid

You may also qualify for Medicaid, which can be used as secondary coverage alongside your Medicare insurance. 

Extra Help

For those with Medicare coverage on the device, you can also sign up for the Extra Help program if you have a limited income. It helps to significantly cover out-of-pocket expenses for prescription drugs. You can see if you qualify on the Social Security Administration’s website. 

Insulin affordability changes

Since 2021, the Centers for Medicare & Medicaid Services (CMS) started testing enhanced Part D plans (called the Senior Savings Model) to help Medicare recipients with diabetes save on insulin costs. This ensured that those needing insulin would not pay more than $35 for it. After the Senior Savings Model was discontinued, the Inflation Reduction Act maintained this cost limit of $35 or less per month for insulin. You can learn more about insulin savings with Medicare here.

Medigaps

You can also see if you qualify for a Medigap plan, which is supplemental insurance you’ll use in addition to Medicare to help with any out-of-pocket costs.

Free SingleCare coupons

And here at SingleCare, we love to help you save. We have coupons available for FreeStyle Libre, which offer savings of up to 80% for the device. Check them out to see if you’ll save on the innovative device. 

Additional Medicare coverage for diabetes 

If you have diabetes, here’s what else Original Medicare typically covers in regard to diabetic treatment and supplies.

RELATED: What does Medicare cover for diabetics?

Medicare Part B coverage

Medicare Part B covers many different items in terms of diabetic supplies. In general, you’ll pay 100% of these medical supplies costs until you have not met your Part B deductible. After you meet the deductible, you will pay 20% and Medicare will pay for the other 80% if you have diabetes and meet the necessary requirements. You can see a full breakdown in the Medicare Diabetes Coverage PDF. 

Here’s what diabetes care is typically covered under Medicare Part B:

• Diabetic screening tests
• The Medicare Diabetes Prevention Program
• Diabetes self-management training
• Diabetes supplies and equipment, including blood sugar test strips, lancet devices, and lancets. Usually, there is a limit to how many of these supplies you can get each month. 
• Blood glucose monitors, Medicare will cover the blood glucose monitor if you qualify, and your doctor writes a prescription for a specific device justifying why you need it. This could be the Medicare-approved FreeStyle Libre system or the Dexcom G5 CGM.
• Foot exams and treatment
• Glaucoma tests

Medicare Part D coverage

Medicare Part D, which is prescription drug coverage, also covers some diabetic supplies. Medicare Part D covers: 

• Anti-diabetic drugs
• Diabetic supplies to administer insulin, like gauze, syringes, and alcohol swabs
• Insulin that is not administered via an insulin pump