Right now I am covered by a working persons health insurance policy and don't have to take Medicare until I lose 'working persons' coverage. I also have my own FEHB BC/BS which is my secondary (because I am not working). If/when, I lose the 'working person's' coverage (but keep FEHB BC/BS), I will go on Medicare and am concerned about insulin pump coverage. I have been told both that Medicare will and will not cover a pump for a Type 2. I called the feds BC/BS and the lady said that they have their own system and that the pump would be covered at the usual rate. Since I don't have her statement sign in blood, in triplicate, I don't trust what she said. Is there anyone on the site that is a Type 2 who has had a pump and pump supplies covered by FEHB BC/BS and/or Medicare. I also have a CGMS. So if anyone has had that covered, I would be interested to know how they got it.
It is my understanding that Medicare will not cover pumps or pump supplies. I have BCBS thru my employer and it is my understanding that my coverage will not change after I retire but my company policy will pay secondary to Medicare.
This worries me too since I have never seen it in writing.
If your company will pay secondary and your coverage will not change, what does that mean? I am making up numbers here,for normal insurance paying secondary to Medicare and if for other things, Medicare pays 80% and secondary pays 20%, will your BC/BS pay 80% or what would be normal for being secondary to Medicare---thus 20%? I have also been told that secondary insurance companies usually won't cover anything that Medicare won't cover. Also, what BC/BS will pay in a contract with one company may not be covered by a contract with another company.
I would like to see something in print, in triplicate and signed with blood.
When and IF I learn anything more, I will let you know. I am 71 and my husband may retire in the next year or two, so I am a bit anxious to know what will happen. I am hoping that someone on this site will have FEBH BC/BS coverage and can give me some info. I have posted this question on the insulin pumps forum and gotten no reply.
If you are type 2 and already on an insulin pump when you go no Medicare, all pump supplies and insulin for use in the pump is covered at 80%. I physically received my pump Dec 27, 2011, went live on the pump Jan 10,2012 and went on Medicare in Feb of 2012. My Medicare Advantage plan pays 100%, so I have not paid for any pump supplies, test strips or insulin. Test strips and insulin for use in pumps is covered under Medicare Part B. Make sure that your provider files the claim under Part B and not D. Wallgreens is reported to be a national chain that files on Part B. Whether or not Medicare will cover a replacement pump for a type 2 is still to be determined.
At this time CGMS is not covered for anybody. There is a bill in congress to get coverage of CGMS for type 1 diabetics.
Update: I have now lost working person’s insurance and am on Medical. However, I have kept my BC/BS as secondary, not as a Medical supplement. This means that I am paying a lot to keep a secondary. However, this also means that pump supplies and Dexcom CGM are covered. According to BC/BS, when the doc writes a prescription for a pump, stating that it is necessary, it will be covered. It is my understanding that a Medicare supplement will not cover these things for a type 2.
Hi, Suzan. I appreciate hearing about your experience. Which pump are you using? I start Medicare in Sept and I will be keeping my Fed BCBS. I’m using Omnipod and my supplies (the pods) are not covered under Part B Medicare but BCBS will cover as they do today (15% copay for a durable supply). Medicare will cover the Omnipod controller (PDM) every five years. It hurts my brain trying to figure out why Medicare would cover “half” of a pump system… But meanwhile I can’t find an answer for is… that if you use a pump, supposedly the insulin cost moves from Part D as a drug to Part B as a pump supply. Did you find this to be true? I’m Type 2. BCBS would not approve CGM for me but I started on a pump this past Jan with great results so far. But what a jungle to sort through all the info and mis-info on the shift to Medicare w/FEHB. Had BCBS tell me that they would cover 100% any labs denied by Medicare because they aren’t “normal” for Type 2’s and that was a bit of good news. I’m very happy with Omnipod but am going to have to look closely at the numbers to have Medicare/BCBS cover at 100% plus insulin costs vs 15% copay on part of the pump and copay on the insulin. This with Medicare costs added to the monthly BCBS costs which surprizingly, do not reduce even a dime after Medicare becomes primary. But after all said and done, I’m still thankful to have FEHB.
Hi, I will answer some now and do more later (tired). I am Type 2, have been on Animas since 2009 and Dexcom one year later, I payed for the Dexcom myself at first because at that time my primary was Operating Engineers (hubby). I only payed for it thr first year, don’t remember what changed. Went on Medicare in 2015, keeping FED BC/BS which is paying for my Dexcom. DO NOT give up your full FED BC/BS for a supplement. A supplement will not cover anything Medicare doesn’t cover. To keep it is costly but our diabetes is expensive. As a side, Medicare won’t cover overseas and last year I was hospitalized in Seoul, Korea. My FED BC/BS paid most of it.
For myself, I would not get Omnipod. I know it would fall out and from what I know, sometimes it is a hassle. Before the pump, I didn’t like the idea of always being attached to something by tubing. It was not an issue, got used to it immediately… Have some funny stories about it. Hope this helps, will answer more in a day or two.
It is true that insulin for a pump and test strips are covered by Part B. I pay nothing for these supplies. I did ask FED BC/BS about covering the Dexcom because, at that time, it wasn’t covered by Medicare for Type 2.
Been thinking some more about how the Dexcom was paid for, after my first time self-pay. I was covered by OE3 as primary with the Feds as secondary. When I got Medicare with Feds secondary, I think my doctor just wrote a prescription for it, probably saying it was needed, and sent it to Feds. Once I
It is true that insulin for a pump and test strips are covered by Part B. I pay nothing for these supplies. I did ask FED BC/BS about covering the Dexcom because, at that time, it wasn’t covered by Medicare for Type 2.
Been thinking some more about how the Dexcom was paid for, after my first time self-pay. I was covered by OE3 as primary with the Feds as secondary. When I got Medicare with Feds secondary, I think my doctor just wrote a prescription for it, probably saying it was needed, and sent it to Feds. Once I was told by FED BC/BS that they have their own policies not related to what Medicare will do. A couple of days ago, I called to find out when I could get a new
pump, like in how many years. Was told that whenever doc writes prescription for pump, that it is needed, that a new one would be issued.
Suzan
Yes, I’m keeping my Fed BCBS just still reconciling in my head that the
monthly premium doesn’t change a bit even though Medicare becomes primary.
I really like the Omnipod since no tubing really appeals to me. But
getting insulin and test strips covered 100% would save me about $850/yr.
Guess I’m going to have to consider changing pump brands so glad to hear
that you and many others have good experience with conventional pumps.
Would love hearing any experience you wish to share. Thanks!! glenna
