Help! Just found out that Medicare DOES NOT cover Omnipod:insurance/providers had OKd

I was misled by Vendors,Insurance, and Insulet and opted for Omnipod. I love the system: it is my first system and I am loathe to say adios. Can anyone recommend a tubed pump for easy transition, given that some accommodation can be made for the 4yr rule? MDI five times a day with R-500
still was not getting good A1c or control. How did I find this out? The provider that my insurance company sent me to, advised that my 2nd 3month shipment was not just delayed, but was unfilled!!
stress out, Suzanne

I went through the same thing..with AARP medicare complete. I fought for 2 years...I opted out of that eventually, and got Medicare Blue. (BCBS) THEY do not follow medicare guidelines and I'm getting my pods paid for... I feel like I won the lottery, as I was paying out of pocket for 2 years. Is Medicare Blue an option for you?

I dread the day I have to go on medicare. Been using the pod for 4 years and in 5 years will be 65. So Medicare Blue does cover the pod? What does this cost and what is the deductible? can you share?

It is hit or miss but check with the medicare advantage HMO plans in your area. With many trial & tribulations I was able to get Humana to cover the Omnipod system. Omnipod actually negotiated a coverage contract for me. Other plans, like Senior Dimensions, flat refuse all pumps. Often your Endo can help so talk to him/her. Copay should run the usual 20% of the contract price. In my case that comes to 150/3months.

The next best system, IMO is the Animas "Ping" . It has the tube delivery, but at least has a remote similar to the PDM. The new Medtronic may be good but I tend to be conservative about trying new devices fresh out of the gate with what may be minimal advances in technology. Insurance companies will probably be slow to accept as well.

Since the Omnipod is considered a "disposable device" you should not be affected by the 4 (5?) year rule on pump systems.

Barbra, with the Tea party and Republicans holding to their present course, there is no prediction possible of what Medicare and associated plans will be like in two years, let alone 5.

Certainly…it’s a Medicare advantage plan. There is no deductible with an advantage plan. A little of your SS is deducted to cover the plan. If the advantage plans still exist when your time comes, it’s the way to go!
I am paying $65 for a 3 mo supply of pods.

Dee, Omnipod is not approved by Medicare - I believe only Medtronic is at the present time - so coverage will depend on the specific company underwriting the Medicare Advantage plan. Mine just cut back test strips to 5/day, a bit annoying since I test 10x per day.

Yes, I know Medicare will not cover the omni pod…but, as I posted, Medicare Blue advantage plan has Care Centrix, they cover it…

I was hoping to find out more about your coverage-sounds ideal. Is this a plan through Blue Cross Blue Shield with the name "Blue Advantage"? Did Insulet help you find the plan?

It’s a PPO not HMO …

We live in SW Florida. It was one of the Medicare advantage plans that were available. It started about 2-3 years ago. At the time I took it, I didn’t know they would cover my pump. I put in an application, to my extreme happiness!, they covered me.

It’s called MEDICARE BLUE ,
My test strips now come from Sterling Medical, just changed from Edgepark, I get the pods from Insulet.

Funny, everyone from day 1 told me Medicare doesn't cover the Omnipod. Even insulet. As far as your A1C, Omnipod helped me get mine lower.

Omnipod is not approved by Medicare. Some Medicare Advantage, or advantage plus plans will. It is up to the insurance company how far beyond Medicare the wish to go. Ultimately it comes down to the bean counters and how smart they are

I also looked into the ping before going with the omnipod so I'm a little familiar and would probably be my next choice. But will not be happy. I may consider going back to pens. I also check 8-10 times a day and worry about getting covered. Let's hope for the best over the next several years.

I live in Texas, the only Advantage programs offered is Physician's Health Choice (a United Health Care off-shoot) Humana is the only other listed in the Medicare for You publication and according to the 2014 coverage, no more Omnipod. I took a c-peptide test to see if I can qualify for another tubed pump and I think that the Tandem, T:slim fits my personality better and that will be my choice. I am spending a lot of time researching Gap/Supplement plans as they pay ALL deductibles and co-pays and would be more cost effective even if they have a monthly fee. It pains me to change plans, but nickel-diming adds up also. The separate Part D hunt goes on as well. Medicare will do an 80/20 deal on insulin used in a pump and when I called them about using my Part D until I reached the 'hole' they said that it was illegal to do so: it's Part B all the way. I swear I will only accept a 'Blood Oath' in the future and not take anyone's word or email as truth.