Animas Ping/Medicare? (don't want to count my eggs before they hatch)

Diabetes Technology Insulin Pumps
1

Hi Everyone! I am in the process of trying to get a pump. I will be dropping off my paperwork with my diabetes center so their rep can get insurance coverage. I am currently looking at the Ping (first option) and Omnipod (second option) and was wondering are they covered under Medicare? I have Medicare as well as a Humana Gold Choice.

Thanks!

2

I am on Medicare (plus regular insurance) with a Ping, but I'm Type 1. They definitely are more stringent with Type 2's and will want to check your c-peptide. I would ask the pump company to check it out for you.

3

I'm new to Medicare and have been reading a lot about its diabetes coverage. I read this Medicare document about Medicare's coverage for diabetes supplies. This pamphlet contains this:

Insulin pumps worn outside the body (external), including the insulin used with the pump, may be covered for some people with Medicare Part B who have diabetes and who meet certain conditions .

I'm not sure what "meet certain conditions" means but I've read elsewhere that Medicare may require a C-peptide blood test below a certain value to qualify for a pump. In other words, this test would indicate pump coverage for people with type 1 diabetes but not type 2. It's good that you're working with an advocate at your doctor's office to help with this. I believe that anyone who wants to use an insulin pump to treat diabetes should have access to one.

Good luck with this.

4

Also be aware that Medicare does not cover omnipod even if you meet the c-peptide requirements.

5

I assume that your Humana Plan is a Medicare Supplement. Medicare will pay for the pum, supplies and insulin depending on what your C-Peptide reading is. My medicare supplement plan is Plan F and it with Medicare cover the fulklk cost of the pump, supplies and insulin. It is my understanding that Medicare does not cover Omni-Pod. Also Medicare requires a 5 year warranty rather than the standard 4 years.

6

Thank you, everyone! I am dropping off my paperwork tomorrow at Diabetes America (my Diabetes Center) and the rep will contact the companies I have chosen to see what is covered (Animas, Tandem, and Omnipod.) I am leaning towards the Animas still, but we'll see what insurance says. Thank you, again!

7

I heard back from the tandem rep today. They were the first ones to call back. They are faxing over requests for the c-peptide blood draw. Wondering what the value needs to be in order to be covered, or in order to make my chances higher at being covered?

8

My Quest Diagnostics lab report shows a reference range from 0.80-3.10 ng/mL. I’m a T1D and my number was less than 0.10. Not sure what the coverage threshold would be. I would ask the tandem rep that question.

9

Thanks, we'll see what happens. Waiting to hear back regarding when I have my c-peptide

10

I believe that most insurance companies base their policies upon Medicare. Medicare requires that your c-peptide is less than or equal to 110 percent of the lower limit of normal of the laboratory’s measurement method. In Terry's example where the lower limit was 0.8 ng/mL you would have to have a c-peptide lower than 0.88 ng/mL.

A c-peptide test is only considered valid by Medicare if your blood sugar is < 225 mg/dl. If you private message me I will give you some suggestions on how to approach this test.

11

Thank you :)

12

Hi Brian, thanks! I messaged you :)

13

Thank for the info :)