Chris, thank you for your feedback. As John described, I had no success speaking /emailing with representatives from the Medicare Part D Providers in my area to find out what my out-of-pocket cost would be for the Omnipod G7/G6 pods. They simply could not give an answer. Like John, I contacted Omnipod at 1-800-591-3455. I was transferred to a helpful representative who asked me to visit Omnipod.com (click the drop down for Is Omnipod Right for Me, Then Cost & Coverage, then Medicare Coverage) while on the phone with him. He said every plan listed is guaranteed to offer the Omnipod G7/G6 Pods. Interested in the Medicare Part D Drug Plans (not Medicare Advantage), I made a note of the ones listed which are available to me in my zip code in Maryland. I investigated Cigna and UHC/AARP and chose the AARP Medicare RX Preferred from United Health Care (PDP).
Visited https://www.aarpmedicareplans.com/health-plans/plan-summary/20832/031/2025#PDP and was able to find my prescriptions on the formulary, including the Omnipod G7/G6 pods. My husband offers the following info:
Log into medicare.gov
Select health and drug plans
Select Find health and drug plans
Put in Zip code - find plans now
Select Medicare Drug Plan Part D
Find Plans - AARP Medicare RX Preferred from UHC (PDP) came up for me
Select plan details
Select plan website
Enter zip code / View plans
Add drugs
Select view drug costs
View costs by month – This is what the Omnipod G7/G6 will cost me as a Tier 3 product (although I picked Omnipod G7/G6 Pods, the website records the name as Omnipod 5 G6 on my list of drugs
Drug Price $363.2
Plan Pays $316.20
You Pay $47
The Omnipod Representative I spoke with stated that Omnipods are listed as a Tier 3 or Tier 4 drug in all plans. Tier 3 drugs have less out-of-pocket costs than Tier 4 drugs. If the Omnipod is listed as a Tier 4 Drug on the insurance formulary of the plan you are decided on, you may request your doctor to complete a Tiering Exception For. “Tiering exception: Ask the plan to cover your drug on our list at a lower cost-sharing level if this drug is not on the Specialty Tier.” If approved this would lower the amount you pay out-of-pocket for your drug. I hope this information proves helpful.