Buying Supplies Directly

I have been using the OmniPod as my pump for over a decade, and I love the freedom and the control that I have with the system. I would not want to change to anything else. However, my husband and I were talking yesterday about healthcare costs since this next year he has to go on Medicare. Since I am a couple of years younger, I am still covered under my past employer’s healthcare plan. We are trying to budget for the future, so he said, “Well, your Pods cost $900 for a three month supply, so once you go on Medicare, we will have to pay $3600/ year just for the Pods.” However, that $900 calculation is based on my present insurance plan’s “negotiated price.” My question is this: Does anyone who is either on Medicare or is without insurance buy the OmniPod directly from Insulet? If you do, does Insulet negotiate a price with private individuals? If they don’t, can anyone tell me how much I should put away each month to pay for a three-month supply? I don’t have tons of money, and I do love the OmniPod system, but if I do not start to stash away money now for the future, I am afraid I will have to give up using the Pods. Any information you have would be very informative and helpful. Thanks.

I don’t have an answer to your questions about Omnipod costs for individuals without insurance. I know you prefer the Omnipod system and I don’t think it’s fair that Medicare will not cover the Omnipod system. Have you tried any other pump?

If you try another pump system and really don’t like it then you can be confident in taking a more expensive path during your Medicare years. If you try another pump and find it acceptable then you will create another option for yourself once you’re Medicare eligible.

Sorry you’re forced to make this choice. I hope you can make a plan that will work for you.

Last I talked to them, it was $300 for a box of ten pods. There was no talking them down or getting a discount for bulk buy.
That may change someday, but that was last year’s policy.

Sorry you have to deal with that. I wish I could help you more.

Thanks, Terry4. I don’t think that Medicare covering one pump and not another is fair either – or even, possibly, legal; however, that seems to be the way that the government runs these days.

I fought using a pump for years because I could not wrap my head around tubes and machines hanging off my belts. I find the infusion insertion clumsy and the sites limiting due to the length of the tube. Then my Endocrinologist said, “What if you can get a tubeless pump that you can wear in various places and infuse with just a push of a button?” I was sold. I know that this mental hangup about tubes is mine, but I guess I would rather go back to MDI than go to a tubed pump.

We’ll have to see what happens in the next two years. I turn 63 this year, so I have that amount of time left to get this all figured out. Right now I just know that I have to save every penny I can now to pay for my healthcare once I hit Medicare.

Thanks for your response, Eddie2. I am currently paying $300/ box now, but that is supposedly with my insurance- negotiated discount. I will be thrilled to pieces if after I lose that insurance, I can still privately purchase my Pods for the same price. According to my insurance Explanation of Benefits, though, the cost per box will be much higher. I know that without the power of group insurance on my side, I might be out of luck.

I guess I should just call Insulet and have a heart-to-heart talk with someone; however, I cynically doubt I will get a straight answer. I understand that no one can predict what costs will be two years from now, but I am not optimistic that prices will go down or that the diabetes community will win the fight to have OmniPods covered under Medicare.

Until then, I just will have to continue to save, save, save. Where healthcare is going in this country (USA) is more uncertain and scary every day.

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I get both my pump (Tandem) and cgm (Dexcom) directly from the manufacturer, and pay cash. In both cases, they were very up-front and able to immediately tell me how much everything would cost, and if there was any cash discounts to be had.

Hi SherryAnn,
It really is $300 for a box of 10 if you go direct to Insulet (that is for the current pods, no telling what the new pods will be when they come out with the new PDM…).

Different insurers have different negotiated prices with Insulet. So, for example, if your insurer pays $500 per box, but only charges you $300, then that’s why the insurer told you it would be “much higher” to buy direct. But it’s not!

But really, for users who call and order straight from Insulet, right now it’s $300 per box (actually, it’s $299. :slight_smile: )

Here’s the number to buy:
Insulet, 800.591.3455, use option 2 for sales

Good to know. Right now I can still get the Pods through my insurance company, but after I am on Medicare, I will have to pay for them myself. That is why I am trying to save for the future.

Thanks for the input, Daytona. In one respect, I am looking forward to going back to directly getting the Pods from Insulet in two years. I used to do that with no problem. Then my insurance carrier decided that I would have to get them through Edgepark, and, as many of you know, that is where the problems started. I will have to argue with them again next month about sending me my next three-month supply. They never look at the notes and records they have on me until I call them up and make them do that. Sigh. At least I expect the hassle now and know how to handle it.

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None of my business, so sorry for asking, but if you can get them straight from Insulet at the same price, and Edgepark gives you troubles, why not just go straight to Insulet?

Just asking because I’m curious, and I’m always trying to see if there’s a better way. :grinning:

Eddie2, at this point, I am using the insurance coverage I have and hassling with EdgePark because once I meet my deductible (usually by the end of February), then the insurance will pay 80%. Yes, I have to cough up $2000 at the outset, but that is easily reached with orders of Pods ($900), blood sticks ($800), insulin ($300+), and a blood test. By March 1, the deductible is met. By June of each year, the 20% payments generally add up to the final maximum out-of-pocket $1000 ($3000 total), and then everything is paid 100%. I also get a pittance of contribution into an HSA from my former employer, so I will hassle with EdgePark to get what I worked over 30 years to gain. From June forward, all supplies I order, any prescriptions I have, and any procedures I need are all covered for me at no charge. So overall, sparring with EdgePark is worth it for now. That will, of course, change in another couple of years when I hit Medicare.

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Ok, that makes sense. I wasn’t thinking about the change after the out-of-pocket is met. I just wanted to make sure they weren’t making you pay too much. I’ve had dealings with Edgepark for supplies, and I have been frustrated by them! So I am glad you have the numbers calculated so well !

Yeah, I have to calculate to “stay whole” financially. I pay heavily at the beginning of the year, but then I pay nothing later on. Essentially, I pay for the February and May Pods, and then I get the August and November shipments free. I actually retired from my job early so that I would be covered by the insurance under my “exit” contract. If I had waited a couple more years, I would not have the retirement coverage I have now. As I said, I put in my 30 years, but I know that I am blessed with the insurance I currently have. Granted, I lost the income I would have earned had I worked longer, but that did not cover what I have gained in insurance coverage for me and for my husband. Life is always a balancing game. We know that in living with diabetes, and we know that from trying to balance our finances.


Although traditional Medicare does not cover pods, some Advantage plans do. When you get closer to Medicare age, you will have to do research of the plans offered in your area. I do know several seniors getting Omnipod coverage through Advantage and Cost plans. But if you choose the option of traditional Medicare with a Supplement plan, you will not have coverage until Medicare policy is changed. The whole issue is related to how the Omnipod fits (or doesn’t fit) into Medicare’s definition of Durable Medical Equipment.

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I have looked into the Advantage program, but for a couple of reasons, that does not work for me. I will have to go with traditional Medicare and a supplemental plan. Sadly, my husband has looked into the supplemental insurance that we will use, and it does not cover diabetic supplies. We are one of the most wealthy countries in the world, and our healthcare system has become so corrupt that they have more power than the government, and the common man and the elderly must suffer because of it. Sad state of being.

Medicare B covers testing supplies and pump supplies (of course unfortunately not Omnipod at this point.) If you use an insulin pump, insulin is also covered under Part B.

So although your Supplemental Plan might not cover the additional 20%, Medicare Part B covers 80% of those things.

Yes, I am happy that Part B will cover a portion of the cost of insulin. We all must take what we can get. I really wonder, as do all other Americans, what Medicare will look like (and cover) two years from now. Time will tell…