I am rapidly approaching Medicare and wanting to know what my options are. I am currently on the Omnipod and Dexcom. If you are on Medicare and on a pump or CGM, please let me know which you are on and how much Medicare covers. I would appreciate any information.
Linda
Go to www.medicare.gov and enter this in the search bar:
Medicare Coverage of Diabetes Supplies & Services.
Then click on the title and you will be taken to a page where you should then click on: View Adobe PDF - 11022 (size: 4.64 MB) Revised 11/1/2008
This is a pdf document that covers diabetes and supplies questions. You can search the file or read it through. Basically, Medicare does cover pumps and insulin (under DME -durable medical equipment).
I have Medicare and had to take a c-peptide blood test to prove that I was diabetic (after 23 years as a T1). It may be that you now have to take two different blood tests, not sure. Regardless, it is a senseless requirement but must be done.
Medicare allows a new pump every 5 years with the only exception being if the pump quits on you. I timed it so I got a new pump just before going on Medicare, but it isn’t necessary. My current pump is 5 1/2 years old and I will get a new one in July. My choice to wait the extra 6 months.
I have a good secondary insurance that pays the 20% that Medicare doesn’t pay. Be sure to check out any secondary insurance for their policy on pumps, supplies, and cgms, just in case–and remember that policies can change from year to year.
Medicare does NOT pay for a cgm. So if interested, check with any secondary insurance on that.
PS. Never hesitate to call Medicare and ask your questions. They have always been helpful to me. Yes, you wait a while to get on but it is worth it. If you get a non helpful person, call again at a different time. I never got one of those but some have reported they did.
Nell,
Thanks for the link. I downloaded the pdf file and read most of it. I knew if I put out a question, someone would respond with pertinent info. Thanks again.
Linda
Prior to me going on Medicare I was on the omnipod and Dexcom. When I turned 65 I learned Medicare would NOT cover the OmniPod or the Dexcom. Medicare does, however, cover the cost of a traditional tubed pump, provided you meet certain criteria.
Best wishes to you and your search for information. I keep hoping Medicare will cover the CGMS someday.
So what pump did you switch to, or did you go back to MDI?
Thanks for your help.
Linda
One other place to look for Medicare info with pumping and CGMS is at: http://www.insulin-pumpers.org
There are a lot of knowledgeable folks on pumps with Medicare. I don’t think anyone is getting covered for CGMS, but there is at least one man who is going through the complete appeal process with Medicare. I have 6 years before I get to Medicare and definitely dread it. I know that there will be so much to learn in order to navigate through the system. I think it’s important to get the right secondary/supplemental insurance and right now I don’t know anything about that. Plus the whole health care system will probably undergo huge changes before I get to Medicare age. The current system is unsustainable from a financial point of view.
At insulin-pumpers there are people on Medicare using Animas and Medtronic pumps. No coverage of Omnipod at this time.
Lathump, (by the way, is it La-thump or Lathum-p?) I have tried the insulin-pumpers.org site two different times, years apart. I never could figure out how to access any real discussions on the site. The discussions I ran across were mostly inane conversation amongst people who were regulars on it–not much about diabetes. So there may be a way to make it work but it was Greek to me. Also, you get streams of emails requesting donations about 4 times a year, maybe more. Not knocking it for those for whom it works but I guess I wonder how you found out how to work the site to get to any meaningful discussions.
Insulin-pumpers.org is kind of a clunky board with it’s email format, but I still find it a good resource because of the knowledge of many of its members. There are definitely members who are successfully navigating through Medicare with pumps and I consider it a good resource for Medicare questions. I don’t post there very often, but whenever I do, I’ve gotten helpful answers to my questions.
If you don’t want to deal with the fundraising emails, just put a filter on your email to block the posts.