Gestational diabetes (GD) is diabetes that can occur during pregnancy. Individuals with GD may benefit from wearing a device called a continuous glucose monitor (CGM), which monitors blood sugar levels throughout the day and night.
Most insurance plans will cover a CGM in part or in full, as long as a person meets certain criteria. However, a person should with their insurance provider for confirmation.
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According to the American Diabetes Association (ADA), GDM affects up to 9% of pregnancies in the United States (US) each year.
As the ADA explains, individuals with GDM or other forms of diabetes mellitus may benefit from a continuous glucose monitor (CGM).
This is a wearable device with special sensors that continuously monitor glucose levels in the fluid beneath the skin. The CGM monitors glucose levels throughout the day and night, without the need for traditional “finger prick” blood glucose monitoring.
According to Medicare.gov, Medicare may cover a continuous glucose monitor (CGM) as well as CGM sensors and transmitters if a doctor confirms that an individual meets all the following criteria for Medicare coverage:
- The person has diabetes mellitus.
- The person takes insulin, or has a history of low blood sugar.
- The person has a prescription for glucose testing supplies, and has received instructions on how often to test blood glucose levels.
- The person has received training on how to use a CGM that their doctor has prescribed, or has a caregiver who has received training in its use.
- The person makes routine in-person or Medicare-approved telehealth visits with their doctor.
Some private insurance plans may also cover a CGM for gestational diabetes. A person can contact their private insurance provider to check if they offer coverage, and whether that coverage covers part or all of the cost of a CGM.
Insurance coverage for gestational diabetes can vary according to the type of insurance a person has, and the specific benefits the insurance policy offers.
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Some insurance plans may offer full coverage, while others may offer part coverage. A person can contact their individual insurance provider for clarification.
Medicare Part B Medical Insurance covers up to two blood glucose laboratory test screenings for individuals with any of the following risk factors for diabetes:
- a history of high blood sugar
- a history of abnormal cholesterol and triglyceride levels
- high blood pressure
- obesity
Medicare Part B Medical insurance also covers these screenings for individuals who meet two or more of the following criteria:
- The person is 65 years of age or over.
- The person is overweight.
- The person has a family history of diabetes.
- The person has a history of gestational diabetes, or delivery of a baby weighing more than 9 pounds.
A person can find out more about Medicare coverage for a CGM by visiting the Medicare website, or by asking a doctor if Medicare covers a CGM or any other medical supplies or services.
People with private health insurance can contact their insurance provider to find out about CGM coverage.
Below are some answers to frequently asked questions about insurance, CGMs, and gestational diabetes.
Does insurance pay for a continuous glucose monitor?
According to the Medicare website, Medicare may cover a CGM in addition to CGM sensors and transmitters if a doctor confirms that an individual meets all of the criteria for Medicate coverage.
Some private insurance plans may also cover a CGM. A person can contact their private insurance provider to check if this is the case.
Is FreeStyle Libre approved for gestational diabetes?
FreeStyle Libre is a CGM, which the company claims is the number 1 CGM brand in the US. According to the company, Freestyle Libre are the most affordable CGM systems, even for people without insurance coverage.
According to the Freestyle Libre website, both the FreeStyle Libre 2 system and the FreeStyle Libre 3 system are approved for use during pregnancy for individuals with any of the following conditions:
- gestational diabetes
- Type 1 diabetes
- Type 2 diabetes
Gestational diabetes (GD) is diabetes that can occur during pregnancy. Individuals with GD may benefit from wearing a continuous glucose monitor (CGM), which can help individuals to maintain healthy blood sugar levels.
Most insurance plans will cover a CGM in part or in full, as long as a person meets the necessary criteria outlined in the insurance plan. A person can contact their insurance provider for more information.
Medicare covers CGMs and CGM sensors and transmitters for individuals with gestational diabetes or other types of diabetes mellitus, as long as their doctor confirms that they meet certain criteria. Under the Affordable Care Act, Medicare as well as most private insurance providers must also cover testing for gestational diabetes.
A person can use the Medicare website to access more information on coverage for a CGM, or coverage for gestational diabetes. Alternatively, they can ask their doctor for additional advice and information about Medicare coverage. Individuals with private insurance policies can contact their insurance provider for further details.