How To Get CGM: Insurance, OTC, And Cost Explained!
Getting a CGM (continuous glucose monitor) means facing two separate decisions: how to obtain the device — whether you need a prescription or can buy one directly — and how to cover the cost, whether through insurance or out of pocket.
Many people searching for how to get cgm or cgm how to get find answers that address only one of these questions. This guide covers four core paths: obtaining a CGM with a prescription, purchasing an OTC device without one, navigating insurance reimbursement, and lower-cost options when you have no insurance.
As the SIBIONICS team with years of research experience in CGM and diabetes management, we put this practical guide together to help you find the right approach for your specific situation.
What You Need Before Getting A CGM?
Taking a few steps before you start can save significant time and back-and-forth later.
First, clarify your purpose. If you have diabetes and rely on insulin to manage your blood glucose, you will generally need a prescription to get a CGM. If you do not use insulin, or simply want to understand your glucose patterns, you may be eligible to buy an OTC CGM directly without a prescription.
Second, gather your insurance information in advance. Knowing whether you have private insurance, Medicare, Medicaid, or no coverage at all will determine which reimbursement path is available to you — and the conditions and cost-sharing vary significantly across plan types.
CGMs on the market today fall into three broad categories. Prescription CGMs in the US include Dexcom G7, FreeStyle Libre 3, and Medtronic Guardian 4 — which is typically used within hybrid closed-loop insulin delivery systems rather than as a standalone CGM.
OTC CGMs in the US include Dexcom Stelo and Abbott Lingo. A third category is CE-certified medical-grade SIBIONICS CGM, designed for people with diabetes in the European market.
If you plan to pursue a prescription or insurance coverage, prepare your diabetes diagnosis documentation, recent blood glucose records, and the most recent A1C test results before your appointment.
How To Get A CGM With A Prescription?
Step 1: Confirm Your CGM Eligibility With Your Doctor
The first step is confirming that you qualify for a prescription CGM. According to the CDC, the people who benefit most from CGM are those with type 1 diabetes and those with type 2 diabetes who use insulin [1].
The NIDDK also notes that your doctor may recommend a CGM if you need insulin to manage type 1 diabetes, type 2 diabetes, or another form of diabetes [2].
Bring your recent blood glucose records, diabetes diagnosis documentation, and your most recent A1C report to the appointment. Your doctor will use these materials to assess clinical necessity and decide whether to issue a prescription.
Step 2: Get Your CGM Prescription
Once your doctor confirms eligibility, they will write a CGM prescription specifying the device model, number of sensors, and usage frequency. The prescription is typically sent directly from the clinic to a DME (durable medical equipment) supplier or pharmacy.
Many insurance plans require prior authorization (PA) before approving CGM coverage. According to research published in the Journal of Managed Care & Specialty Pharmacy, obtaining a CGM through the DME channel requires physicians to create and submit documentation to the DME supplier to obtain a PA for coverage [3].
The same research notes that many providers report that prior authorizations delay treatment and negatively impact clinical outcomes.
If your plan requires a PA, your doctor's office typically handles the paperwork — you only need to provide supporting medical records when asked.
Step 3: Choose A Pharmacy Or DME Supplier
There are two main channels for filling a CGM prescription: a retail pharmacy (such as Walgreens or CVS) or a DME supplier.
The timelines differ considerably — per the AMCP research, patients often wait 3–4 weeks for delivery from DME suppliers compared with 1–2 days from a local pharmacy.
If you are on Medicare, CGM reimbursement runs through the DME benefit channel. Regardless of your plan, confirm that your chosen supplier is in-network before placing an order to avoid unexpected out-of-pocket charges.
Step 4: Set Up And Activate Your CGM
Once your device arrives, download the manufacturer's companion app and pair it with your smartphone. Follow the instructions to insert the sensor on the back of your upper arm, in an area with adequate soft tissue, and press firmly to secure.
Before relying on the readings, go through the initial setup with your doctor or nurse to confirm you can correctly interpret the data and respond to alerts. Work with your care team to set glucose alert thresholds appropriate for your treatment plan.
How To Get A CGM Without A Prescription?
Some users can skip the prescription process entirely. According to the American Diabetes Association 2026 Standards of Care, anyone can purchase OTC-CGM devices, including those without diabetes or with prediabetes [4].
Per the same ADA guidance, these devices support people who wish to assess their glycemic responses to their lifestyles, including the effects of food choices and exercise.
In the US, OTC CGMs available without a prescription include Dexcom Stelo and Abbott Lingo, both purchasable through retail channels.
Before choosing, comparing different cgm brands for intended users, wear duration, and feature sets will help you select the right fit.
OTC CGMs are not right for everyone. Cleveland Clinic notes that OTC CGMs may not be suitable for people who use insulin to manage diabetes or who experience significant low blood sugar episodes [5].
If either applies to you, consult your doctor before purchasing and consider a prescription device instead.
For users in Europe, the GS3 SIBIONICS is a CE-certified medical-grade CGM designed for people with diabetes in the European market and is available through European official channels.
How To Get A CGM Covered By Insurance?
Step 1: Review Your Plan's CGM Coverage Policy
Call your insurer's member services line and ask whether CGM falls under your DME benefit or pharmacy benefit, and confirm which CGM brands your formulary covers.
Understanding how to get cgm covered by insurance starts with knowing exactly what your plan includes and which eligibility criteria apply.
Per the CDC, most private insurance plans, Medicare, and Medicaid cover CGMs for people with type 1 diabetes. CGMs are typically also covered for people with type 2 diabetes who take daily injections (like insulin), use an insulin pump, or have had severe low blood sugar.
Also ask about your annual deductible, copay amount, and coinsurance percentage — these figures determine your actual out-of-pocket cost once coverage kicks in.
Step 2: Complete Prior Authorization If Required
Many private insurance plans and Medicare require prior authorization (PA) before approving CGM coverage.
Typical documentation includes your diabetes diagnosis, evidence of insulin use or hypoglycemia history, and your doctor's clinical necessity statement.
Research shows that PA processes impose a significant administrative burden on providers and delay patient access to treatment. Your doctor's office typically submits this paperwork on your behalf — confirm the timeline with the clinic staff so there are no unexpected delays.
Step 3: Fill Your Prescription Through An In-Network Supplier
Once PA is approved, choose an in-network supplier to fill your prescription and minimize your cost share. If you are unsure which suppliers are in-network, call the member services number on the back of your insurance card.
Funds from a FSA (flexible spending account) or HSA (health savings account) can typically be applied to CGM out-of-pocket costs. When purchasing cgm supplies, confirm your cost share upfront so you can budget for ongoing sensor replacements throughout the year.
How To Get A CGM Through Medicare Or Medicaid?
Medicare covers CGMs through the Part B DME benefit. Per the AMCP research, CMS expanded public coverage of CGM in 2023 to all insulin-using individuals with type 2 diabetes.
The same research confirms that this expansion also covers individuals with type 2 diabetes with a history of problematic hypoglycemia, regardless of treatment regimen.
Medicare CGM reimbursement runs through the DME benefit channel. Contact 1-800-MEDICARE or ask your prescribing physician to confirm current supplier requirements in your area before placing an order.
Medicaid coverage varies significantly by state. Per the CDC, Medicaid typically covers CGMs for people with type 1 diabetes and qualifying insulin users. Contact your state Medicaid office directly to learn the specific eligibility criteria and application process where you live.
How To Get A CGM Without Insurance?
Without insurance, the annual cost of CGM can be substantial. Per the CDC, CGMs can cost thousands of dollars per year without insurance coverage.
Most major CGM manufacturers offer patient assistance programs. Patients who meet income or clinical criteria may qualify for device or sensor subsidies — check each brand's official website for eligibility requirements and application instructions.
Discount platforms such as GoodRx can reduce the pharmacy purchase price of some prescription CGMs and are worth checking before you fill a prescription.
If you do not use insulin, an OTC CGM such as Stelo or Lingo is a lower-barrier option that requires no prescription and no insurance approval.
European users can access CE-certified medical-grade CGMs such as the SIBIONICS GS3 through official European channels. Comparing cgm suppliers by sensor wear duration and bundle pricing can help control annual costs.
Verdict
Getting a CGM comes down to two decisions: choosing your path (prescription vs. OTC) and sorting out payment (insurance vs. self-pay).
If you use insulin or have a history of hypoglycemia, the prescription-plus-insurance route is the most appropriate — confirm eligibility with your doctor, obtain a prescription, and complete any required prior authorization.
Fill your prescription through an in-network DME supplier or pharmacy. If you do not use insulin, an OTC CGM offers a direct, prescription-free way to get started. Whichever path applies, discuss the options with your doctor first to confirm the best fit for your clinical situation.
FAQ
Q: Can I get a CGM without a doctor?
Adults who do not use insulin can purchase OTC CGMs such as Dexcom Stelo and Abbott Lingo directly without a prescription, per the ADA 2026 Standards of Care. If you require insulin or have a history of significant low blood sugar, you will need a prescription CGM from your doctor, and a prior authorization process may also apply.
Q: How do I qualify for a CGM with insurance?
Per the CDC, most private insurance plans, Medicare, and Medicaid cover CGMs for people with type 1 diabetes and for people with type 2 diabetes who use insulin daily. You will typically need a physician-issued prescription, and many plans also require prior authorization. Contact your insurer's member services line to confirm the exact requirements for your plan.
Q: How much does a CGM cost without insurance?
Per the CDC, without insurance coverage, CGMs can cost thousands of dollars per year. Manufacturer patient assistance programs, GoodRx discounts, and OTC CGMs — which are generally priced lower than prescription devices — are three options worth exploring to manage costs.
Q: Does Medicare cover continuous glucose monitors?
Yes. Medicare Part B covers CGMs through the DME benefit. Per a 2023 CMS policy update, coverage was expanded to all insulin-using individuals with type 2 diabetes and those with a history of problematic hypoglycemia, regardless of treatment regimen. Contact Medicare or your DME supplier to confirm your specific cost share.
Q: Can non-diabetics get a CGM covered by insurance?
Per the CDC, insurance typically does not cover CGM use for people without diabetes. Non-diabetic individuals who want to understand their glucose patterns can consider purchasing an OTC CGM — such as Dexcom Stelo or Abbott Lingo — which requires no prescription and no insurance, per the ADA 2026 Standards of Care.
References
[1] Centers for Disease Control and Prevention. (September 30, 2025). Continuous Glucose Monitors. cdc.gov. https://www.cdc.gov/diabetes/treatment/continuous-glucose-monitors.html
[2] National Institute of Diabetes and Digestive and Kidney Diseases. (June 2023). Continuous Glucose Monitoring. niddk.nih.gov. https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes/continuous-glucose-monitoring
[3] Marshall C, et al. (2024). AMCP Market Insights Health Plan Best Practice: Implementing continuous glucose monitoring to improve patient outcomes in diabetes. J Manag Care Spec Pharm. https://pmc.ncbi.nlm.nih.gov/articles/PMC12148013/
[4] American Diabetes Association Professional Practice Committee. (2025). 7. Diabetes Technology: Standards of Care in Diabetes—2026. Diabetes Care. https://pmc.ncbi.nlm.nih.gov/articles/PMC12690173/
[5] Cleveland Clinic. (May 24, 2024). Continuous Glucose Monitoring (CGM). my.clevelandclinic.org. https://my.clevelandclinic.org/health/articles/continuous-glucose-monitoring-cgm
Disclaimer
This article is for educational purposes only and does not replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
Author Information
This article was written by the SIBIONICS Professional Health Content Team. The author has years of research experience in CGM and diabetes management, helping users optimize their device experience through science-based practices.
Last Updated: April 30, 2026
Related Reading:
1.How To Get A CGM Prescription: 5 Quick Steps!
2.Does Medicaid Cover CGM 2026: State Coverage!
3.CGM News 2026: ATTD Highlights & Device Updates
