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For our Medicare Advantage members

Continuous Glucose Monitor (CGM) Coverage

Certain medical equipment that is ordered by your doctor for medical reasons is classified as durable medical equipment (DME). Under Capital Blue Cross plans, covered items include, but are not limited to: CGMs, wheelchairs, crutches, powered mattress systems, diabetic supplies, hospital beds ordered by a provider for use in the home, IV infusion pumps, speech generating devices, oxygen equipment, nebulizers, and walkers.

You can find a list of our DME suppliers by visiting the Capital Blue Cross MyCare Finder. Generally, the plan covers any brand of DME covered by Original Medicare from this list of suppliers; however, Continuous Glucose Monitors (CGMs) require you to use a preferred manufacturer purchased from a network pharmacy for the in-network cost sharing to apply. This coverage is limited to Dexcom and FreeStyle Libre brands only. Prior authorization may be required and is the responsibility of your provider.

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PPO members:

We will cover other CGM brands and manufacturers at a higher cost-share unless your doctor or other provider tells us that the brand is appropriate for your medical needs.

HMO members:

We will not cover other CGM brands and manufactures unless your doctor or other provider tells us that the brand is appropriate for your medical needs. However, if you are new to the plan and are using a brand of DME that is not on our list, we will continue to cover this brand for you for up to 90 days. During this time, you should talk with your doctor to decide what brand is medically appropriate for you after this 90-day period. (If you disagree with your doctor, you can ask him or her to refer you for a second opinion.)

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If you (or your provider) don’t agree with the plan’s coverage decision, you or your provider may file an appeal. You can also file an appeal if you don’t agree with your provider’s decision about what product or brand is appropriate for your medical condition. (For more information about appeals, see Chapter 9 of your Evidence of Coverage, What to do if you have a problem or complaint (coverage decisions, appeals, complaints).)

Questions?

Contact a Member Service Representative with questions:

HMO members: Toll Free 800.779.6962 (TTY: 711), Monday through Friday, 8:00 AM to 8:00 PM ET, with extended hours October 1-March 31.

PPO members: Toll Free 866.987.4213 (TTY: 711), Monday through Friday, 8:00 AM to 8:00 PM ET, with extended hours October 1-March 31.

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Updated January 1, 2025

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