My brother has to buy a new insulin pump. His insurance co-pay is 20%. His pump died about 2 hours ago. My brother will begin Medicare in 24 days and his co-pay will be zero in 24 days. His pump died 24 days before a zero co-pay. His warranty ran out in April, but he had gotten a new pump about 10 months ago, because his old pump malfunctioned. His last insulin pump couldn’t last 11 months. You’ve got to be kidding! It just died. Does anyone know how much an insurance co. pays for an insulin pump? I’ m trying to get an idea.
If it will be under medicare, the rules are different. Medicare usually does a 5-year pump program/warranty. The first 13 months you “rent” the pump and usually make monthly payments. Followed by 4 years of use, covered by mfg warranty.
But may also vary based on what kind of plan.
When you get warranty replacement from pump mfg, it is usually a refurbished pump, which may explain why it lasted only 10 months. I have used a replacement medtronic pump for over a year, and recently switched to Tandem T-Slim X2.
The cost will depend on the plan, Medicare Advantage may cover differently.
Hope some others will post their experience, I’m not on medicare.
I wasn’t asking how much it costs for Medicare because I don’t think he can wait 24 days. If he could wait 24 days the pump would be free. His insurance right now would require him to pay 20% of the insurance company’s contract price with the pump company. Every insurance company isn’t going to have the exact same co-pay, so I’m just trying to get a ballpark idea of what the 20% would be. Someone who has recently bought a pump would probably remember how much the pump cost.
It depends on his insurance and what pump he picks. For math’s sake, you could guesstimate a pump to list at ~$7,000 US, but in all honesty it could range from 5k-9k. There’s lots of screwing around with prices in the insurance game. So plan on roughly $1,400 down, plus pump supplies. If you’ve already reached the max out of pocket, though, it could be free. You won’t know until you pick a pump and do a benefits check though the manufacturer.
Personally, I’d go back to injections for the month if it meant getting a free pump! Or maybe someone local could spare him an old backup pump.
I’m with @Robyn_H , go back on injections for 24 days. It would be well-worth it financially.
My tslim was billed to my insurance at about $6500. I paid bout 3000, since I then met my max out of pocket.
@Looking_for_Answers. After reading your post, I have a crazy question. Most people using an insulin pump are taught to have an ‘insulin pump emergency kit.’ Your brother should have a plan to manage his blood sugar in case of pump failure until a replacement pump can be delivered. What is his pump failure plan?
For example, my pump failure plan includes actions for being pumpless for more than a month. I have long acting and rapid acting insulin, syringes, alcohol wipes, etc.
You did not share who made the pump that failed. Knowing who made the pump will allow the people on this forum answer from experience and those with other pump brands to read and learn.
During this time, look for the best pump for your brother. Check out all of the brands, features, and physician recommendations. Check with the doctor’s diabetes educator or pump trainer for information. My recommendation is the Tandem t:Slim with Control-IQ technology. My out of pocket was zero.
Does your brother use a CGM. Dexcom G6 is built in to the Tandem pump.
Let us know what you all do. Sharing helps all of us learn new and better answers.
That makes sense to have a plan in place. Ironically, the current pump was going to be the back-up pump for the new pump. The endo my brother had when he got the pump didn’t help with anything. My brother does have insulin & syringes. I didn’t think about someone having a spare he could use. Our healthcare system doesn’t do anything to help people with diabetes .All endo offices should have spares available for patients. My brother has a t: slim G4 Tandem.There’s not a lot of competition with insulin pumps. I thought he would get another Tandem. But this last pump didn’t even last a year! What a rip-off!!! I have a pocket calculator I’ve used for 30 some years. It sounds like Tandem doesn’t want their product to last. I found a website that sells used Medtronics. Some of them were 10 years old. Corporations nowadays have such low standards. It’s as if we don’t push them to have high standards. A $3000 co-pay is outrageous.
I would advise to avoid Medtronic. There have been malpractice litigations against Medtronic for “runaway” pumps resulting in the user’s death.
BTW, what part of the US are you in? Someone here may be able to guide you in your locality.
I’m in KY. Thanks for the heads up on Medtronic.
If someone could loan a pump for about a month, I would pay for the loan. I would pay for the overnight.
True, but a relatively small number compared to the total pumps out there. I have used medtronic pump for over 25 years.
Have you talked with Tandem, possibly request a loaner you would pay rental on by month and return when medicare covered pump is received. Keep in mind it will take some time to get pump under medicare.
I just got my tandem it was $980. For me. That’s a 20% copay. But it might be discounted from my insurer.
A medical device death is one death too many. You may be in the 99.9% but it is the pits to be in the 0.1%.
Thank you everyone for your input. MM1, I did call Tandem & they said they will send a loaner pump for a month, provided my brother signs an agreement stating that he intends to buy a Tandem pump in Sept. My brother already has an appt for Sept 2 to discuss the new pump. MM1, I really appreciate your suggestion.
Actually, now Tandem is saying they only give a loaner pump to people who are “in process”. I’ve asked Tandem to define in process. I haven’t got an answer yet, but apparently my brother doesn’t qualify. I am so mad! Everything about our healthcare system works against people with diabetes. We need someoneto make pumps to last longer than a year.
What about Omnipod? It doesn’t work for everyone, but it’s great for others. Seems to be a love it or hate it thing. It’s more expensive for monthly supplies, but the startup cost is less than with Tandem or Medtronic. You’d only have you cover the copay on the controller (cell phone looking PDA device). It can also be covered as a pharmacy benefit, rather than DME, if that’s more affordable for you.
I don’t really know how switching to Medicare works, and if they know about existing in warranty devices. I would think he’d be able to pick whatever pump he wants right away under new insurance because they shouldn’t have record of his equipment. But if they do, covering the Omnipod under pharmacy benefit means there’s no strings attached, and switching to a different pump later is more easy.
How do you keep insulin available for a pump failure that may occur once every three or four years