Various parts of Medicare help to cover FreeStyle Libre. However, there may be some out-of-pocket costs, such as a 20% copay.
The FreeStyle Libre flash glucose monitoring system allows a person to measure their blood sugar level continually.
This article discusses FreeStyle Libre and diabetes. It also looks at Medicare coverage, additional costs, and where to find Medicare-approved suppliers.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
The federally funded health insurance program called Medicare includes:
Medicare considers designated blood glucose monitoring systems, such as FreeStyle Libre, to be durable medical equipment (DME). Therefore, Medicare Part B will help pay for a portion of the costs.
However, some qualifying requirements apply, including:
- having diabetes mellitus
- having a prescription for testing supplies and instructions on how often to check blood sugar
- having a history of issues with low blood sugar or taking insulin
- having training on how to use a continuous glucose monitor as prescribed
- making regular Medicare-approved telehealth visits with a healthcare professional
Part D
Medicare Part D will generally cover the costs of insulin that a person administers as a result of their FreeStyle Libre readings.
However, if a person uses an insulin pump, Medicare Part B typically covers their insulin. A person cannot have both an insulin pump and the FreeStyle Libre system under their Medicare coverage.
Current status of in-person meetings with a doctor
Before the COVID-19 pandemic, an individual had to attend several in-person meetings with their healthcare professional to discuss their blood sugar management.
However, Medicare has temporarily expanded its telehealth service until December 31, 2024, which allows a person to have a virtual visit with their healthcare professional without leaving home or having to go to a hospital or a doctor’s office. After the end of 2024, individuals will once again be required to see their healthcare professionals in person.
Different parts of Medicare will provide coverage for FreeStyle Libre. However, a person may have additional out-of-pocket costs, and they will also have to pay for replacement sensors.
Costs for FreeStyle Libre vary. According to the manufacturers, a person with private insurance will pay a monthly average of less than $40 per month for FreeStyle Libre CGM sensors.
Part B
Although Medicare Part B may cover some FreeStyle Libre costs, a person might still be responsible for out-of-pocket costs. For example, they must first meet their Part B deductible, which is $240 in 2024.
After meeting the deductible, a person then pays 20% of the Medicare-approved amount for their FreeStyle Libre. Reimbursement rates may vary by year.
Medigap
If a person has a Medicare supplement insurance plan, also known as Medigap, the plan may help cover their out-of-pocket costs.
Medicare Advantage
A Medicare Advantage plan will provide coverage for FreeStyle Libre, although a person may have to pay the 20% Part B copay.
Help with costs
If a person needs help paying the Part B copay, they may get support through Medicaid, a state and federally-funded program that provides medical financial assistance.
Medicare also offers an Extra Help program. This can help cover the deductibles, copays, and coinsurance costs associated with Part D plans. Individuals can qualify for Extra Help if they have an income of $22,590 or less and a resource limit of $17,220 or less.
Diabetes is a medical condition
In people with type 1 diabetes, the body does not make sufficient insulin and needs external insulin administration.
Type 2 diabetes means that the body cannot effectively use insulin to manage blood sugar levels. As a result, a person may need insulin injections or medications to improve their body’s ability to use insulin.
Monitoring and maintaining blood sugar levels is important to a person’s health when they have diabetes. Medicare covers a variety of diabetes medications, testing supplies, and diabetes-related medical visits to help a person manage this condition.
FreeStyle Libre is a continuous glucose monitoring (CGM) system that allows a person to check their blood sugar in real time without having to prick their finger.
The system has two components– a glucose sensor that the person applies to the skin and a digital reader. A person can apply the sensor to the back of their upper arm and leave it in place for a maximum of 14 days.
The sensor monitors a person’s blood glucose by measuring glucose levels in the interstitial fluid, which is the fluid between the cells and the blood vessels. A person can hold the digital reader or smartphone with app over the sensor to obtain a blood glucose reading.
What other CGMs or insulin pumps does Medicare cover?
As of 2018, Medicare also covers the Dexcom G5 CGM, which is another continuous glucose monitoring system.
The Dexcom G5 and FreeStyle Libre are different than insulin pumps, which can monitor and administer insulin. Medicare also covers some types of insulin pumps.
A person can speak with their healthcare professional about what monitoring approach may be best for them.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Medicare may cover the FreeStyle Libre as a means to help manage type 1 or type 2 diabetes, although a person must meet certain criteria.
A person who frequently monitors their blood sugar and administers insulin may qualify for Freestyle Libre, which requires a prescription.
While Medicare covers much of the cost of these continuous glucose monitors, a person may still incur out-of-pocket costs. Programs, such as Extra Help, may cover some of these costs.