Insulin pump & Medicare

I guess a lot has changed since the last time I was here and trying to navigate so I guess I’ll start a new thread in regards to pumps and medicare. I wanted to ask about CGM as well so I hope its ok to ask here.

I’ll soon be on medicare (7/1) as my other insurance will be terminated tomorrow 6/30. I cant elect to stay on my current insurance as I collect SSI. I was reading the medicare books and I am lost, confused and having anxiety.

  1. anyone who has medicare how did you get your supplies?
  2. what is involved in getting your supplies, etc?
  3. currently I have the animas ping. Should I stay on this pump or try a different one (omnipod would be too big on me)?
  4. Animas has the animas vibe which has the CGM integrated into it. I want to get this pump so I have one unit but when I read the medicare book, CGMs arent covered. So for those that has both, how did you get it covered?
  5. what is the cost on supplies as I dont have much money but worried about the co-pays if any?

Thanks to all that can give me advice, suggestions, etc

I’m interested as well. As of right now CGM’s aren’t covered but there is a bill in congress requiring it to be. Google it and let your congress person know you need it! I’m pretty sure that insulin pumps are covered but not the Omnipod, of course, that’s what I’ve been on for several years. I don’t know where or how you get supplies but I imagine that the “part” that has prescriptions might cover the insulin?? But again, not sure. Seems like I’ve heard that insulin for pumps isn’t covered the same as insulin pens etc. I’m curious about all this also so hopefully someone will respond with better information.

Hi Amy - I started on Medicare last year. If you haven’t already, read this Medicare publication about Medicare and diabetes.

I have a Ping, too, and get my pump supplies under Medicare Part B from a third party vendor called CCS Medical. There are other Medicare suppliers out there. Like any prescription item, the doctor must order it. CCS sends me a 90 supply every 90 days.

They usually call me to find out if I’m ready for the next shipment and always want to know the date of my last diabetes doctor appointment. Medicare requires that we see a doctor every 90 days in order to receive Part B supplies.

I understand that you can get insulin under Part B if you use a pump but I had some trouble with that decided to get my insulin under my mail order Rx plan that I have as retirement benefit from my former employer.

I get my test strips under Medicare Part B from Walgreens. Medicare enforces strip limits unless your doctor appeals on your behalf for more. My doctor ordered and Medicare approved 14/day for me.

Medicare will not cover CGMs. Again, my retiree medical coverage picks up my CGM supplies for me. Most “Medi-gap” policies will only pay for items that Medicare covers. Fortunately for me, my policy will pay 80% for my CGM stuff.

Medicare will pay for an insulin pump every five years but there are some very specific rules that govern this coverage. Having an insulin pump before going on Medicare is an advantage for eligibility. I have no experience with this yet since my pump is only three year old. Search TuD, click on the magnifying glass icon in the upper right of this screen, and use the search term “Medicare insulin pumps.” Alternately, you could just Google using that same term to reveal the Medicare page that lists those rules.

I pay about $90 out of pocket for pump infusion sets and cartridges for a 90 day supply. I pay Walgreens about $18/month for my test strips. I’m not sure about the insulin Medicare Part B cost since Walgreens half-heartedly tried to get my to pay several hundred dollars for Apidra insulin. That’s why I switched back to my mail order plan.

Good luck with securing your diabetes supplies. Be persistent and do your research. Medicare has lots of information available online.

I am interested in opening this discussion again as things may have changed significantly. My specific question is about what I have heard is a requirement for Diabetics on Part B pumps to have their pump and insulin prescriptions reviewed/renewed quarterly or the prescription may not be honored. Does this have to be with an Endo or can my PCP do this if willing? Are these quarterly visits paid for by Medicare? (I seldom go to my doctor more than once now.) I will also be traveling for months at a time, Lord willing, in retirement and I would therefore need to set up virtual appointments. Thanks for any thoughts and experiences!

It might be better to raise a new topic.
The 7 year old discussion is irrelevant now due to so many changes in medicare.

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OK will copy to a new one.

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I agree. One thing I dislike about this forum is when posts from years ago are revived. I always laugh when someone previously had a question that warranted an immediate answer and then they get an answer 5 years later!

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Some old topics are still relevant, but Medicare/healthcare, or pumps/cgms/insulins are changing quickly.

That is somewhat true, but in most cases I think after about a year it would be better to start new posts and maybe have links to the old posts.

As I think about “wrong” information, I should probably go through my blog and update posts with current information or al least add a note saying that that some things in this post may be outdated. When I started my blog, CGM was not covered by Medicare. And then there was the requirement banning smartphone use. Etc. and etc. Also discussions about test strip coverage are dated. Most of the changes I’ve seen in Medicare have been good. The whole issue of test strip coverage while using G6 is murky because some people are getting strips and others aren’t.

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