Insulin under Medicare Part B or D with Omnipod?

Type 1 and LADA
1

Does anyone using the Omnipod who is on Medicare get their insulin under Part B? I realize that the Omnipod itself is under Part D.

I am signing up for a Medicare Supplement this week and am considering Cigna for medical and pharmacy.

2

My understanding is that insulin for a tubed pump is covered under Part B because it is part of the supplies for a DME device which is covered under Part B. For that reason I do not think that insulin for an Omnipod will be covered under Part B. That being said, I know at least two people who are getting their Omnipod insulin with Part B. Frankly I think that they are lucky and the “mistake” will eventually be discovered. But I am starting Omnipod in order to trying Looping. I may try to get the insulin covered under Part B and see what happens. On the other hand, I might not try that initially because I don’t want to mess up my Part B insulin if I go back to my Tandem pump in a month or two. I have Cigna for my Part D plan and the Omnipod and Omnipod Dash are both on formulary. My first Omnipod order will arrive tomorrow and there were no issues getting it covered by Cigna. The first order is expensive because of the PDM and the $400 deductible for Tier 3.

There is no doubt that using Omnipod with Medicare and a supplement plan is much more expensive than a tubed pump. With a tubed pump I have no out of pocket expenses with the pump, its supplies, and the insulin. It is still TBD how much more Omnipod will be. But right now I am buying time by Looping under the Dexcom G6 starts being delivered to Medicare recipients and I can use Basal IQ with my Tandem pump.

2 Likes
3

Thanks for thorough response. I asked someone in the Omnipod reorder department yesterday and they said I can use Part B for the Humalog for my Omnipod. My doctor is giving the test to show Type I in case it’s requested to get insulin under B. She thinks B will cover my insulin. We shall see.

I did get Cigna for Supplement and Secure Extra for Prescriptions.

I started using Omnipod to use different sites for a while but I am getting to like it. I had used tube pumps for almost 20 years. My blood sugar is better…but that maybe the Dexcom G6.

1 Like