Medicare Coverage for FreeStyle Libre 3
The FreeStyle Libre 3 is covered by Medicare Part B, but patients typically pay 20% coinsurance after meeting their Part B deductible—it is not provided completely free of charge. 1
Coverage Status and Patient Costs
Both FreeStyle Libre systems and Dexcom G6/G7 have achieved broad Medicare eligibility, making them among the most accessible CGM options for Medicare beneficiaries. 1
Medicare Part B covers CGM systems as durable medical equipment (DME), with the standard cost-sharing structure requiring beneficiaries to pay 20% of the Medicare-approved amount after meeting their annual Part B deductible. 2
The FreeStyle Libre systems have lower direct costs compared to real-time CGM systems, which may result in lower out-of-pocket expenses for the 20% coinsurance portion. 2, 1
Requirements for Ongoing Medicare Coverage
Medicare requires strict documentation to maintain CGM coverage:
The device must continuously measure glucose and display data in real-time >95% of the time for the duration specified in the product label. 1
Comprehensive reports and validation of glucose values must be documented in electronic health records to support ongoing coverage. 1
This documentation requirement is critical—failure to meet these thresholds can result in loss of coverage.
Clinical Eligibility Criteria
Medicare coverage decisions are based on medical necessity:
Coverage is well-supported for patients with type 1 diabetes on insulin who require real-time monitoring for optimal glucose control. 1
Patients with hypoglycemia unawareness or frequent hypoglycemic episodes have particularly strong justification for CGM coverage. 1
Patients with type 2 diabetes on multiple daily insulin injections are also eligible for either real-time or intermittently scanned CGM based on clinical need. 3
FreeStyle Libre 3 Specific Considerations
The FreeStyle Libre 3 is factory-calibrated and does not require fingerstick blood glucose calibrations, which reduces overall monitoring costs and burden. 1
However, be aware of potential accuracy limitations:
High doses of acetaminophen, salicylic acid, and ascorbic acid can affect CGM accuracy with glucose oxidase-based sensors like the FreeStyle Libre. 2, 3
The system should be used with caution in patients on hemodialysis due to lower accuracy compared to other methods in this population. 2
Common Coverage Pitfalls to Avoid
Do not assume "Medicare coverage" means zero cost—the 20% coinsurance still applies unless the patient has supplemental insurance (Medigap) that covers this portion.
Ensure patients scan the sensor at minimum once every 8 hours to avoid data gaps that could jeopardize documentation requirements for ongoing coverage. 3
Verify that the patient's specific clinical situation meets Medicare's medical necessity criteria before prescribing, as coverage can be denied without proper documentation.