I plan to join the original Medicare Part B with a supplemental Plan F (UHC via AARP) and a Medicare Part D (by WellCare -ValueScript PDP) in November 2019. I am currently using Tandem T:Slim Pump for the insulin injection. Before signing up for any plan, I would appreciate to know:
Presumably, Doctor’s pump supply prescription and supporting data need to be sent to UHC for approval, since the insulin pump supply are under original Medicare Part B DME and the deductible/20% copay are under Supplemental Plan F.
Who will supply Insulin (Humalog or Novolog)? UHC or WellCare.
Does Doctor’s insulin prescription need to be sent to WellCare for approval if Wellcare supplies insulin? WellCare then delivers insulin and collect the copay from UHC. Can WellCare refuse?
Wellcare 2019 Formulary includes Insulin Novolog under Part D, not mentioning about under Part B. Will this be a problem?
Will insulin supplier allow for Insulin Pens prescription as a backup in case of pump malfunction if I pay for insulin pens under Part D?
Supplemental plans just pay the remaining 20% of what Medicare covers under Part B. The supplemental plan has no role in deciding what is covered; it is a Medicare decision. Your Part D plan has no role in your Part B insulin and its formulary has nothing to do with what insulin you can receive. Part B does not have formulary restrictions and I know people who are getting Novolog, Humalog, Apidra, and Fiasp.
You will get your insulin from a retail pharmacy such as Walgreens, Walmart, Kroger’s, CVS, etc. I suggested in another post that @Dave44 work with Walgreens and provided the phone number for the Walgreens National Medicare department. But you can start by talking with whatever local pharmacy you want to use although it is best to use a large chain, Not all Mom & Pop pharmacies (are there any left?) are licensed to dispense Part B insulin which is classified by Medicare as DME. Your doctor will send a prescription to the pharmacy specifying that it is used in an insulin pump, the dose per day, and I think diagnosis code. There is paperwork that has to be done especially the first time that you get Part B insulin. For me my local Walgreens contacted the National Medicare department for me. They gave me a call asking for model and serial number of the pump, when it was purchased, who paid for it, and a few other questions.
Your best bet is a pharmacy with a pharmacist who knows about Part B insulin and/or is willing to learn and do the work. For me that has been Walgreens. Every 3 months when I renew my prescription, I call the pharmacy to remind them that it is Part B insulin. There are still occasional screw-ups where it gets billed to Part D, but they always figure it out.
BTW if you call the Medicare Help Line they won’t have a clue and will tell you to call online DME suppliers, none of which provide Part B insulin, Talk with your pharmacy!
My best source for Medicare information is from a Facebook group called Seniors with Sensors which is mostly comprised of people with diabetes (mostly Type 1) on Medicare. It is a closed group but easy to get approved.
Most of this stuff takes a while to get set up when you start Medicare, so do your best to have a cushion of pump supplies and insulin. And be patient but keep on top of things.
I also use a Tandem pump and called Tandem a few months before going on Medicare. They did some of the legwork to get me set up with a supplier who was very proactive contacting me and my doctor about what needed to be done. For example I was required to get a c-peptide test (my first ever!) but it had to be done once I started Medicare so it would be reimbursed.
Dexcom can be a PITA to get set up with. Chart notes and forms have to be completed perfectly and sometimes it takes a while to get Dexcom and your doctor’s office on the same page. Currently Medicare people are getting G5 but the promise is that G6 will start chipping in October.
Mostly Medicare is OK. It is not as though private insurance is smooth sailing for a lot of people these days…
Under my Former Medicare/United Healthcare supplementary Plan as well as my current Medicare/United Healthcare Group Advantage Plan I was given access to CVSCareMark mail order pharmacy which allows me to order a three month supply (9 vials) at a two month cost - $50.
I contacted two nearby pharmacies, Ralph (Kroger chain) and Walgreen, to inquire their experiences in dealing with Part B insulin supply for pumper, not Part D insulin. Ralph pharmacist said no experience, while Walgreen said Yes. The choice is obvious.
Laddie provided the answers for my next two questions; Tandem pump supplies and Dexcom CGM sensors and transmitter. I visited the local social security office for the application of adding Medicare Part B to my current Medicare Part A and was advised to show up in September for the effective date of November 1st. It would take two weeks to receive the official notification of the Medicare Part B eligibility. Thereafter, I can sign up with insurance companies for Part B supplemental plan and Part D. I will contact Tandem and Dexcom to arrange the enrollment after receiving the eligibility notification. Thanks.
