I’m type 1 for 40 years and turn 65 in August. I will be going on Medicare after having had excellent insurance through my work all these years.
I hear so many horror stories about how Medicare hardly covers anything for diabetes any more, or that they make you change your entire regiment to all new stuff. Right now I’m on MDI but would like to try the Omnipod. I also have a cgm.
I will be eligible for a supplemental plan through my work but other than that, what do I need to know about Medicare as a type 1 diabetic? And, part D???
Medicare with Part D is awesome. I am not sure what you are worried about. You can get Part A and Part B and a supplement which will allow you to pick pretty much any provider in the US plus most overseas for any medical issue and that will cover your CGM 100% and your insulin cost will top out at a maximum of $35 per month. Without the supplement, your CGM will be covered 80%. plus you will have other expenses. If you only require local care and can work within network, you may want to look at Medicare advantage plans, but with the restrictions, I don’t know of many diabetics thrilled with their Advantage plan. I have been on Medicare parts A, B and D for over 10 years, am MDI and have yet to have any issues.
Usually the issues stem at the early stages from doctor’s offices that do not have administrative personnel that are knowledgeable of how to help you set up your prescriptions with for your hardware and medications with the proper provider.
Your best bet is to start at medicare.gov and set up an account to find the insurance plans that best meet your particular requirements.
I agree with @CJ114, Medicare is awesome. Unless you are retired from the military and eligible for Tricare, I’d recommend that you steer clear of all Medicare Advantage plans!
Traditional Medicare with a Supplement works well. Be aware that signing up for a supplement when you first turn 65 does not require any medical underwriting (questions about whether you have certain medical conditions including diabetes). If you try to sign up for a supplemental plan after the initial eligibility period ends, you will need to go through medical underwriting and either get turned down or offered an unaffordable option.
Don’t be tempted or fooled by the “no premium” MA plans with gym memberships or benefits thrown in to distract you from your due diligence. You’ve earned your supplemental insurance during your work years; that’s indeed the best path for you!
Traditional Medicare + a supplement plan is a winner.
Your Omnipods will be covered by a separate Medicare Part D Rx plan. You’ll need to research and buy this plan annually. It’ll take a little effort to identify a plan that covers Omnipod. By the way, if you choose to use a tubed pump, it will be covered under Part B and Medicare will even pay (with the supplement) for 100% of the insulin and supplies.
I started Medicare this year. I chose AARP/United Health for supplemental and part D. I am not a fan of the Advantage plan. If the government calls anything ‘Advantage’, it is a sure bet that it is an advantage for the government and a disadvantage for the insured person. So far everything went very smooth. No issues at all with coverage or deliveries. I have Dexcom G7 and OmniPod Dash.
I love Medicare, with a gap/supplemental plan. A Gap insurance needs to be gotten when you first get Medicare, later it’s almost impossible. Be careful of an Advantage Plan as they can be more limiting of choices. Cheaper if you are on a budget, but they save money by cutting down on your choices.
We have a supplemental plan through my husbands past employer. We had coverage through his work and because Medicare picks up so much of the cost, that plan automatically switched to a gap/supplemental that covers all the costs/copays of Part A and B. Our Part D which is supplied by his past employer too, has a copay for medications, but has covered everything I’ve wanted like Afrezza early on. If your employer has a supplemental/GAP plan, it’s worth checking into.
I have a complete choice of doctors as long as they take Medicare, and most seem too. I don’t need a referral for a specialist. It has some weirder rules sometimes and it can be hard to get answers from Medicare customer service. But Medicare has been wonderful!
What nobody seems to be mentioning with traditional Medicare, when you have an issue, or need surgery, etc. you can research the best doctors and facilities in the country and chances are they take Medicare and you can just go to them for your care. You don’t need referrals, and all the other BS you need to go through to be told where you would get your care through your PCP.
What they all said. Also on Plan D I check every year for the best prescription plan. I do MDIs. If you change your prescription plan at medicare.gov, they cancel your old plan and enroll you in the new one. Make sure your health care provider takes Medicare. My husband has had both knees replaced and a heart valve replaced with no problems with insurance.
I will be starting MC in May. I found a great HC agent/broker in my area, who helped me narrow down and select the best plans for my needs. Was lucky to find out her husband has diabetes and trusted her knowledge.
Ditto what everyone else said. I’ve been on Medicare with a supplemental plan through my former employer for many years, and have had absolutely no problems getting anything covered.
Recently found out that Medicare will pay for CGM supplies and 200 test strips per month. Libre and Dexcom are the two available. After trying Dexcom 7 for 2 months I asked for and was granted, through my insurance that handles Medicare for me a change back to Medtronic’s g4 sensors. I have Cigna Achieve Medicare (HMO C-SNP.). I explained that nighttime highs and lows were common occurrences that were frustrating (not to mention waking my wife up, too.) I explained it that way and that was all it took. As soon as my PCP writes the script I will be on my way. Much better than paying a 20% copay.
I agree with the above posters, I’m pretty happy with Medicare. The downside is that it’s a bit complicated. Particularly when you get into the gap plans as there are about 10 different ones available and some of the coverages can vary by state.
I also am not a fan of the part C plans which are what you see advertised on television. I think they are sort of the equivalent of an HMO vs. Medicare parts A,B & D with a gap plan which is more like a PPO.
I’d recommend that you find a local licensed Medicare insurance agent to help you through the process. They are paid by Medicare so they don’t charge anything for the service. They know all of the plans and can save you a lot of time trying to do the research on your own.
You can find local agents through your State Health Insurance Assistance Program. There will be a link to yours on the Medicare website.
Medicare advisers get paid more if they sign you up for an Advantage plan instead of a Supplement plan. Be aware of that. This is another way the government steers you towards Advantage plans.
I’ll add that the brokers I dealt with could not find Part D plans that cover Omnipod so I had to find that on my own. The only way I could find that Part D coverage was on Insulet web site:
There are definitely very good Medicare advisors out there. The catch-22 is that if you can tell the difference, you no longer need a Medicare advisor.
@Mike3 Medicare is not likely to pay for both a CGM and test strips. A few people have managed to, but??? Usually Medicare will give you the choice of one or the other. I get a Dexcom under Part B, which is Medicare and my GAP covers the copay. My Part D plan does allow me to get test strips and I have several times, but I guess not everyone can.
This is one of those things you can call Medicare and get various answers. I was told yes, no barrier if your DR orders it, I was told only in a bundle, which doesn’t exist anymore, and no. I got it through Part B once and on refill (4 months later) it was turned down as not covered.
I too think Medicare + supplement is fantastic. I have no cost insulin, no cost pump supplies. Medicare customer service is equal to or perhaps a tad better than other medical ins. companies. So, before deciding on a pump check with Medicare to see if that pump is covered. Ditto for CGM. I am using Dexcom G7 (G6 previously) and Tandem t:slim X2. Medicare does require paperwork from your doc and quarterly visits to maintain coverage.
I’m in the same position; April 2025 for me. Having done the research it seems that I need a C-peptide as the absolute first step; I have to have prove that I am a T1 and, given that I was first diagnosed in 1972 in a foreign country (I’m an immigrant) that proof was not readily to hand.
So I’ve done that; I discussed it with my endo (fortunately I have an endo; that took a while too!) He knew the right tests (I trust) and those are now on file. He also does Medicare; this is the second step.
You need an endo that can transition you from private insurance to public insurance. Since many docs simply refuse to do MediCare you have to be absolutely sure you aren’t going to get tossed overboard when you lose your insurance. Since you have employer insurance you might be able to delay the complete transition but that’s a dangerous game so far as I can tell. I pay for my own insurance; I don’t know. Just check your endo will continue to work for you.
Step 0.1: regular US docs can’t handle this. It’s way too complicated for them. You need an endo who does MediCare. It’s expensive but it’s primarily for the transition; once you are through it and MediCare accept you are a T1 things will probably be ok. (Bear in mind I’m saying this without, yet, having gone through the transition myself!)
It really is a good time to feel terrified. Fear protects us.
It’s too late for the Omnipod; at present you are protecting your access to the CGM. Don’t make things more complicated than they are. If you get through the transition then you will be able to talk to your endo about the O5. Endos like the O5 (except for the ones that believe in 1/2" 18G needles).
