diabetic supplies

Navigating your diabetes care: CGM vs. BGM

Diabetes management has come a long way. With advances in medical technology, individuals with diabetes now have more tools than ever to track their glucose levels. Two primary methods for self-monitoring are Continuous Glucose Monitoring (CGM) and traditional Blood Glucose Monitoring (BGM). Understanding the differences between these two is key to finding the right fit for your health and lifestyle needs.

 

How they work: A fundamental difference

The main distinction between CGM and BGM is what and when they measure.
 

Blood Glucose Monitoring (BGM)

A BGM, or glucometer, is a portable device that provides a snapshot of your glucose level at a specific moment in time.
  • How it works: You use a lancet to prick your finger and place a small drop of blood on a disposable test strip. The meter reads the glucose level from the blood sample.
  • Data provided: A single, precise glucose reading for that specific moment.
  • Best for: Individuals who only need to check their levels a few times a day or who need to confirm a CGM reading.
 

Continuous Glucose Monitoring (CGM)

A CGM is a wearable system that automatically tracks your glucose levels day and night.
  • How it works: A tiny sensor, inserted just under the skin (usually on the arm or abdomen), measures glucose in the interstitial fluid every few minutes. A transmitter on top of the sensor sends this data wirelessly to a receiver or a compatible smartphone app.
  • Data provided: A continuous stream of data showing real-time glucose levels, trends, and patterns over time.
  • Best for: Individuals who need more comprehensive data to manage their diabetes, such as those on insulin, or those prone to frequent highs and lows.
Feature
Blood Glucose Monitoring (BGM)
Continuous Glucose Monitoring (CGM)
Measurement Snapshot at a single point in time. Continuous, 24/7 monitoring.
Method Fingerstick blood sample. Sensor inserted under the skin.
Data type A single glucose number. Real-time glucose readings, trends, and alerts.
Fingersticks needed? Yes, for each reading. Significantly fewer, or sometimes none, depending on the device.
Alerts? No. Yes, for high and low glucose levels.
Data analysis Requires manual logging or meter memory. Automatic data logging and trend analysis via apps.
Lag time Almost no lag time for capillary blood glucose levels. Up to a 15-minute lag time compared to blood glucose.
Cost Generally less expensive upfront, but ongoing cost of test strips can add up. Higher upfront cost for the system and ongoing cost of sensors, but potentially covered by insurance.

Choosing the right glucose monitoring system

The best choice depends on your specific health needs, lifestyle, and a discussion with your healthcare provider.
 

When to consider BGM

  • Cost is a primary factor: BGMs and test strips are generally more budget-friendly.
  • For simple management: If you don’t require intensive insulin management or don’t experience frequent glucose fluctuations, a BGM may be sufficient.
  • For occasional use: A BGM is an essential backup for all individuals with diabetes, particularly for confirming CGM readings when they don’t match how you feel.
 

When to consider CGM

  • For real-time insight: The continuous data from a CGM helps you and your healthcare team better understand how food, exercise, and stress impact your glucose levels throughout the day.
  • To reduce fingersticks: For many, the convenience of fewer, or even no, fingersticks is a major benefit.
  • To prevent highs and lows: Real-time alerts can help you avoid dangerous episodes of hypoglycemia or hyperglycemia by giving you time to act.
  • For intensive management: Individuals with Type 1 diabetes, or those with Type 2 diabetes who use intensive insulin therapy, can use CGM data to make more informed treatment decisions.
 

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As a Durable Medical Equipment (DME) provider, we offer a range of products to support your glucose monitoring needs.
 

Blood glucose meters (BGM)

  • Simple meters: Basic meters, like the OneTouch Verio Flex®, offer simple, easy-to-read results on a large digital screen.
  • Connected meters: Smart glucometers, such as the OneTouch Verio Reflect®, can connect to a smartphone app to log readings and identify patterns.
 

Continuous glucose monitors (CGM)

  • Freestyle Libre systems: These are Flash Glucose Monitoring (FGM) systems, a type of CGM. With the FreeStyle Libre 3 system, a small sensor on the back of your arm automatically sends minute-by-minute glucose readings to your smartphone, eliminating the need for routine fingersticks.
  • Dexcom systems: Systems like the Dexcom G7 provide real-time, 24/7 glucose readings with customizable alerts and can integrate with compatible insulin pumps for automated insulin delivery.
 

Supplies and accessories

We also carry the essential supplies needed for each system:
  • Test strips and lancets for BGM devices
  • Sensors and transmitters for CGM systems
Before deciding, we encourage you to discuss these options with your doctor or diabetes educator to determine the best approach for managing your condition. Our trained staff is also available to answer your questions and help you navigate our product offerings.

How do insurance plans usually cover CGM vs BGM?

Insurance coverage overview

Insurance coverage for continuous glucose monitors (CGMs) and blood glucose monitors (BGMs) differs significantly, with BGMs generally covered more easily due to lower cost. CGMs, while more expensive, are often covered for individuals with a higher level of medical need, and coverage has been expanding. 

Requirements for Medicare to Cover Blood Sugar Monitors and Test Strips

  • You must be in treatment for diabetes.
  • Your doctor must accept Medicare.
  • Your supplier must be enrolled in Medicare and accept assignment — meaning they are willing to accept the Medicare-approved price for the monitor and test strips.

Blood Glucose Monitoring (BGM) coverage

Broad coverage: BGMs, along with their testing strips and lancets, are typically covered by most insurance plans, including commercial, Medicare, and Medicaid, as they are considered the standard of care for diabetes management.
Simple criteria: To qualify for BGM coverage, you generally only need a diabetes diagnosis and a prescription from your doctor.
Cost structure:
Commercial insurance: Your out-of-pocket costs will depend on your plan’s copayments and deductibles for durable medical equipment (DME).
Medicare (Part B): After meeting the Part B deductible, you typically pay 20% of the Medicare-approved amount for the device and supplies.
Free meters: Some insurance plans and pharmacies may offer free BGMs, as the more significant, ongoing cost is the test strips.

Continuous Glucose Monitoring (CGM) coverage

 

  • Stricter criteria: Because of the higher cost, insurers typically have stricter eligibility rules for CGMs. For many plans, the device must be deemed medically necessary for your diabetes management.
  • Medical necessity for coverage: You can increase your chances of coverage by having your doctor document your specific needs. This can include evidence of:
    • Difficulty managing glucose levels with traditional BGM.
    • Frequent low blood sugar episodes (hypoglycemia).
    • A need for frequent changes to your insulin dosage.

Medicare (Part B) coverage for CGM:

  • As of 2023, Medicare significantly expanded its CGM coverage. You may be eligible if you have diabetes and are on any form of insulin therapy or have a history of problematic hypoglycemia.
  • An in-person or telehealth visit with your doctor is required within six months of ordering the device and at least every six months after.
  • Like BGMs, CGMs are covered as DME under Part B. After meeting your deductible, you pay 20% of the Medicare-approved amount.

Commercial insurance coverage for CGM:

  • Many commercial plans cover CGMs for both type 1 and type 2 diabetes, often for those on intensive insulin therapy.
  • Coverage can vary greatly by provider and individual plan, with some requiring prior authorization from a doctor.

Coverage under DME vs. pharmacy benefit:

  • Many CGMs are covered as Durable Medical Equipment (DME) under the medical benefit, not the pharmacy benefit. You may need to use a specific DME supplier in your network.
  • For some plans, especially certain state Medicaid programs, CGMs may be covered under the pharmacy benefit, which can mean an easier process and potentially lower out-of-pocket costs.
  •  

Appealing a denial:

  • If your initial claim is denied, you can appeal the decision with the help of your doctor by providing additional documentation of medical necessity. 

Medicare Part B Limits on Test Strips

a

If you use insulin: Medicare will cover up to 300 test strips and 300 lancets every three months.

b

If you do not use insulin: Medicare will cover up to 100 test strips and 100 lancets every three months.

c

Medicare will cover more than the limited number if your doctor declares additional test strips and lancets are medically necessary. You may need to keep records of your self-treatments to show to Medicare as proof.

Next steps to confirm your coverage

  • Talk to your doctor: Discuss which monitoring system is most appropriate for your specific diabetes management needs.
  • Contact your insurance provider: Call the number on your member ID card to verify your plan’s specific criteria, covered brands, and out-of-pocket costs.
  • Consult your DME supplier: If your CGM is covered under the DME benefit, a specialized supplier can help navigate the prior authorization and claims process with your insurance company. 

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