Happy thanksgiving Dick. Agree that Medicare covers pump and supplies. For a tubed pump. I am just very tired of tubed pumps. Omnipod is under Part D. Very expensive. Switching to MDI and will have to pay for pens under Part D. Will see how pens work out. May have to go back to a tubed pump. Thanks for responding.
Can I ask what MDI is? Why isnāt it covered under Medicare?
Medicare is coming up all too soon. 
Multiple daily injections
It is covered under a different area of Medicare part D drug plan
Pumps s are considered durable medical equipment which is either 80% or 100% with the supplemental plan. Not sure why but using a pump with CGM is the optimal treatment for many and fortunately is covered
1 Like
Hi Mika happy thanksgiving. MDI is multiple daily injections via insulin pen or vials with syringes. It is covered under pharmacy Part D. But there is a co-pay. My copay is $47/month per pen. Unless I end up reaching ādonut holeā or Gap. Then is 25% of the total retail cost. Need two insulins. Basal and Bolus.
1 Like
$47 ā per pen??? Not box?
I donāt know why Iām surprised. I know how messed up our drug pricing is.
Just a clarificationā¦ under Medicare, pump supplies and insulin are covered under Part B and not PartD. There is no doughnut hole in Part B. With a supplementary plan, I pay nothing for either supplies nor my insulin.
I do MDIs and I am on medicare. This past year I paid my plan D premium and nothing for my insulin. I had copays on my needles and other drugs. I live in Utah. Looks like for 2022 my premium will be $60.
https://www.cms.gov/files/document/insulin-common-questions.pdf
2 Likes
Havenāt started yet but I believe one month supply. Might be 3 pens to cover. Not sure yet. Each pen last 28 days so they say.
The 28 days refers to the room- temperature shelf life, after opening, of an individual pen or cartridge. Actual usage varies by amount of insulin injected.
A pen is 300 units. So if youāre using 20 u/day as I was when Iām MDI, you get 2 weeks from each pen of Humalog. (I had a second pen with Toujeo for my basal).
Thanks for input. Yes I do know that about shelf life. Just meant that I havenāt researched my actual needs. Probably 1 1/2 pens a month. Donāt start until January. Have also looked into insulin from Canada. 5 pens of humalog is $115 in Canada.
Not a huge savings but have to watch out for the Medicare Gap here. If I reach that will pay 25% of total cost of the insulin. Had better insurance before Medicare. Everything was covered pens pumps etc. as I said just tired of tubed pumps and weighing my options. I appreciate all responses. Itās so awesome to have others to bounce ideas off of.
Medicare Part B which covers durable medical equipment like pumps and insulin for pumps and Part D which is prescriptions. One of the quirks under Medicare, a patch pump or tubeless pump are covered under Part D pharmacy, supposedly because the pods are disposable, and the insulin I think for it might only be under Part D. Iām not sure about that, I use pens for my Omnipod so they are under Part D anyways.
I have a supplemental plan with my Medicare, which is great. All durable (and Dexcom falls under that) is completely covered under Part B. My pods are part D though and are $40 for however many I need for a 3 month supply. Thatās the same with my insulin pens. So $80 every 3 months for my pump and insulin supplies for whatever amount I need, fine with me for getting my preferences. My Afrezza that I have started experimenting with is 22.00 for a months supply.
@Jane16
Getting insulin from Canada is a lot cheaper than here, but if I remember correctly there will also be a shipping charge of about $35???
I switched to Medicare advantage plan last year. Supposed to be for chronic illness like diabetes. Not sure wise decision. No premiums. So save that way. Do you have medigap insurance where you pay monthly premium? I figure what I pay for supplies is still less than my premium was. I knew about the patch pumps. Omnipod has been fighting for years to even be covered by any Medicare. I could afford if it wasnāt for that donut hole rule from Medicare.
We are really lucky in the respect that the plan through my husbands work automatically switched to a supplemental plan. They pick up the costs.