Insulin pumps, mainly Omni pod, and MEDICARE

Does anyone here have a pump, or omni pod and is on Medicare and how is medicare handling this?? It’s an important matter for me…

Thanks guys…


Thanks Dave…I was approved originally but, when I ordered my 2nd batch of supplies, I was denied coverage by Edgepark… I’ve been fighting this for for about 6 weeks.
Edgepark will STILL not cover me!
Today I spoke to the Center for Medicare and Medicaid services (CMMS) who also told me I was covered…Edgepark STILL refuses to cover me.
I am appealing to my ins. co… with an explanation and a Letter from my Endo.
I find this totally Stressful and it’s affecting my health.

What is MM??
Edgepark I feel is good, but they just don’t want to listen that I am covered…
Thanks for responding…

Dee I have been pumping for almost 11 years. The last pump I received January of this year and it was the first I’ve gotten through Medicare. When I started on Medicare in 2005 I had to have bloodwork done, I think it was to establish my C-peptide. I have been a Type 1 most of my life. I have communicated with some people who are Type 2 and are on a pump.

Thank you Betty for your response. . we are probably the same age :slight_smile:
Today, I spoke to someone at the Center for Medicare and Medicaid Services (CMMS) and they told me a pump is a covered service by Medicare if it is proven one is needed. I certainly have proof. I changed from Type 2 to Type 1, end of last year. . Pills no longer worked for me. Regular insulin was sending me to extreme lows and highs in the beginning. My Endo thought a Pump would be just what I needed. He was right! Omni Pod was my choice.
I have sent a written copy of Medicare’s (Pump) Benefits to Edgepark, as they say they follow Medicare Procedures. Edgepark keeps saying it’s not a covered service no matter what I say…

I got my new pump without any problems and am happy with it. It has some new features that I’m able to take advantage of. I guess Edgepark is your insurance company, my secondary is Blue Cross…don’t know if it’s better then what you have but it might be worth looking into.

Edgepark is the distribitor of the pump…not my insurer.
I have a Medicare Advantage Plan,

medicare will cover a pump and supplys at 80/20 split but they will not cover the omni pod pump as of yet

This I don’t understand as Medicare puts out a pamphlet where it’s written they cover insulinm pumps…as durable medical equipment…
publication 11022, page 10

There are still some private insurance companies who won’t cover the omnipod… it doesn’t surprise me, honestly, as it ends up being more expensive than a tubed pump. Not to say I think it’s right, I don’t, I’m just saying, from an economic standpoint, I can see why.

Sorry thought Edgepark was your insurance. I’ve never considered the Omnipod since I was more familiar with MM, which I’ve had two. My first pump years ago was the Disetronic H-plus.

They DO cover pumps, just not that one.

You cannot “change” from T2 to T1.

So, because I want the latest pump, without tubing, … I am penalized?? Does that seem fair ??

Well…I was first diagnosed with type 2, about 5 years ago…NOW, I am told I am type 1…Perhaps I was type 1 originally? Experts have no answer. BUT , for the first 4+ years, I did well on oral meds…

I had a friend who was diagnosed as Type 2 about 20 years ago. After 17 years she was re-diagnosed as Type 1.5.

Type 1 is an autoimmune disease, it is not simply the requirement of insulin.

Have you ever had antibody testing done?

I think if they had a better medical standing. Not to make anyone mad, but it is true. But also you have to change your whole thing out every 3 days, insurance companies would pay for them easier. I wonder how Solo will fare in the insurance war?

Well…This is the pump recommended by my Endo… DIdn’t know it was the "most expensive"one.
.I researched all of them, and liked this the best… This pump is the best that has happened for me since my grandkids were born.
I will continue to fight …As I mentioned previously, MY ins. initally said I was covered.
Thanks for you opinions and input…

A friend has the MM…I believe she has to change every 3 days as well?? She is also thinking of changing to the Omni Pod…more freedom.