Actual Medicare payments for OmniPod thru Medicare Suppliers

Diabetes Technology
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I will be using a Medicare supplement plan and part D prescription coverage beginning in August. I’m having difficulty finding out how much Medicare actually pays for original OmniPod 4 (or OmniPod5) along with Dexcom G6. If you have a Medicare supplement plan and use part D, I’d really appreciate hearing from you about what Medicare actual pays the supplier. (NOT what you pay for deductibles, etc.) Please don’t respond if you have military insurance or use an advantage plan as I imagine those are different. Thank you so much for any help you can give me.

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I have a medicare supplement plan through BCBS of MA. Medicare Part B covers 80% of my Dexcom G6 and my medicare supplement plan covers the other 20% so no out-of-pocket cost for me beyond my insurance premiums. I am not on Omnipod, so can’t help you out on that one.

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It may be based on formulary for RX for your plan. Not sure if all MC plans follow same formulary but have heard Omnipod may be covered by MC via Part D.

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I have Medicare and a great supplement plan through my hubby’s past employer.

Omnipod is always covered under Part D, that is how they got it qualified and they have no plans to change that status. (Unless it’s with the brand new one? I have no idea about that) I pay $40 for a 3 month supply through OptumRX no matter how many I need, in my case I have my script written for changing it every 2 days instead of three. Dexcom is supplied by Medicare as DME and I don’t have to pay anything for it. But that’s because of my supplement plan.

Part B for your Dexcom and Part D for your Omnipod should be standard, but what you pay will depend on what your supplement plan pays for and that can really vary, You should be able to call OptumRx or whoever will be your prescription supplier and ask them the costs with the info of your plans for the pods??? OptumRx has all my info and I can look up online what my costs for everything is. I use ADS (Northcoast) for my Dexcom supplies and they were extremely helpful in setting up the account and submitting all the info for it to be approved. You might try calling them unless you are tied to one DME supplier. You could try calling Omnipod/Insulet, but they don’t seem to really be able to tell you much in relation to coverage unless they submit it and then you know. They haven’t been that great lately about info…

Medicare can tell you what they will charge, but they will not know about your supplement plan benefits.

Ignore where it says insulin pumps are covered under Part B, all others except for Omnipod are. Part D is how Insulet submitted it and got it accepted to be covered through Medicare.

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I have the UHC/AARP Preferred Rx Part D plan. The OmniPod Dash is Name Brand and Tier 4 (or maybe it’s 5) and is billed as a percent of cost. In the initial coverage stage, I paid about $2/pod. Now in the donut hole, I recently paid $14,40/pod, which is the highest in 2 years. I think that’s 25% of charged cost. When I hit the other side soon - catastrophic coverage - it should drop down to about $2.80/pod or 5%. I get these mail order from “Community, a Walgreens Pharmacy.” On the other hand, my insulin is capped at $35/month, regardless of how many vials I need.

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Thanks for these numbers! We must also consider the monthly cost of the Medicare Part D plan. What is your monthly or annual cost for your UHC/AARP Preferred Rx Part D plan? And I guess because you are not getting your pump through Part B, then you must get your insulin through Part D also? (I switched from my great OmniPod pump to a Tandem because of the increase costs!)

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