In 2026, Medicare will undergo pivotal changes affecting diabetes monitor coverage, impacting millions who depend on these devices. The new regulations will alter access to continuous glucose monitors and insulin pumps, while also introducing changes in diabetic test strip coverage and remote monitoring billing codes. Understanding these shifts is essential for ensuring uninterrupted diabetes care.
Upcoming Changes in Medicare Coverage for Diabetes Monitors in 2026
In 2026, significant changes are set to occur in Medicare coverage for diabetes monitors, impacting millions of Americans who rely on these essential devices. 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. This change has raised concerns about potential limitations in access to these critical 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 ensure that Medicare beneficiaries do not face gaps in access, coverage, or affordability as the new changes are implemented (source).
Changes in Diabetic Test Strip Coverage
Starting 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 prevent any disruptions in patient care. It is crucial for providers to ensure that their patients’ blood glucose monitors are compatible with these strips (source).
Medicare Coverage Criteria for Glucose Monitors
Medicare coverage for glucose monitors includes both home blood glucose monitors (BGMs) and 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 Billing Codes
The 2026 CMS Physician Fee Schedule 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 more clinical work can be compensated, even if it falls short of previous requirements (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 staying informed can help prevent disruptions in care. By learning more about these changes, individuals can better prepare for the transition and ensure they continue to receive the necessary support for managing diabetes effectively. Engaging with healthcare providers and staying updated on policy changes will be key to navigating the evolving landscape of diabetes care in 2026.