In 2026, Medicare will undergo pivotal changes affecting diabetes monitor coverage, reshaping access to continuous glucose monitors and insulin pumps for millions. These adjustments, driven by the Centers for Medicare & Medicaid Services, raise concerns about device accessibility and patient care. Explore the implications of these changes and how they will influence diabetes management strategies.
Upcoming Changes in Medicare Coverage for Diabetes Monitors in 2026
In 2026, significant changes are set to take place in Medicare coverage for diabetes monitors, impacting millions of beneficiaries. The Centers for Medicare & Medicaid Services (CMS) has released the final 2026 Home Health Rule, which will alter the coverage of continuous glucose monitors (CGMs) and insulin pumps for Medicare beneficiaries with diabetes. This change has raised concerns about potential limitations in access to these essential devices (source).
Impact on Continuous Glucose Monitors and Insulin Pumps
The American Diabetes Association (ADA) has expressed deep concern that the new rule could disrupt care for patients by limiting access to certain CGMs and insulin pumps. The ADA emphasizes the importance of maintaining patient and provider choice in selecting diabetes management devices. They are actively engaging with policymakers to highlight the need for individualized device selection based on a patient’s specific needs, circumstances, preferences, and skill level (source).
Changes in Diabetic Test Strip Coverage
Effective January 1, 2026, Independence Blue Cross Medicare Advantage plans will no longer cover OneTouch diabetic test strips at the preferred cost-sharing level. Instead, Accu-Chek and Contour will become the only preferred brands. Providers are advised to switch patients to Accu-Chek test strips immediately to avoid disruptions in care. It is crucial for providers to ensure that patients’ blood glucose monitors are compatible with Accu-Chek or Contour strips; if not, they should prescribe a compatible monitor, which is covered by the plan (source).
Medicare Coverage Criteria for Glucose Monitors
Medicare coverage for glucose monitors includes both home blood glucose monitors (BGMs) and continuous glucose monitors (CGMs), along with diabetic accessories and supplies, under the Durable Medical Equipment (DME) benefit. Coverage is contingent upon meeting specific criteria outlined in the National Coverage Determination (NCD) and Local Coverage Determination (LCD) guidelines. For BGMs, patients must have diabetes and demonstrate the ability to use the device, as prescribed by their treating practitioner (source).
Remote Diabetes Monitoring and New Medicare Codes
The 2026 CMS Physician Fee Schedule (PFS) introduces significant changes to Medicare coverage for remote diabetes monitoring, including new remote patient monitoring (RPM) codes. These changes are designed to better accommodate the realities of diabetes care, where patients may not always meet previous thresholds for device data and management time. The new RPM codes provide more flexibility for billing and ensure that clinically meaningful work is compensated, even if it falls short of previous thresholds (source).
Why You Should Learn More About Medicare Coverage for Diabetes Monitors Today
Understanding the upcoming changes in Medicare coverage for diabetes monitors is crucial for both patients and healthcare providers. These changes will impact access to essential diabetes management devices and require adjustments in care plans. By staying informed, patients can ensure they continue to receive the necessary support and devices for effective diabetes management. Healthcare providers can better navigate the new regulations and provide optimal care to their patients. As the implementation date approaches, it is important to stay updated on the latest developments and prepare for the transition to ensure uninterrupted access to diabetes care.