2024 will be my first year on Medicare. I live in Florida. I would like to stay with OmniPod and Dexcom. Are there any Medicare Part D plans that cover OmniPod and Dexcom? Please advise if you know of one and/or are enrolled in one? What is the total cost including copays? Thanks.
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Omnipod has a list of companies for Part D. I had to choose Aetna Silverscript Plus because they are on listed Tier three. My husband has a 10,000 a month chemo prescription and doesn’t need the “Plus.” Makes no sense to me. It was going to be $70 per month. I have a low income assistance so I am at $50 a month and will be $68 for 2024.Dex is Part B. I have not yet tried to fill it.
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@Laura_S, thanks. My understanding is that insurance companies don’t have to cover OmniPod and Dexcom at all under Part D. So why would they? On the open market the cost is more than $1000 per month. If someone uses OmniPod, it is very likely that he/she uses Dexcom too and that for the rest of life. Have you had a full year of getting OmniPod and paid only $50 per month? It seems too good to be true. I want to believe it. It would save me a lot of money.
I have A, B and D under financial subsidy. My grocery store pharmacy does my Dex, supposedly it will be Part B. For me it should be covered fully.
The Omnipod page listed Part D suppliers, all tier three or four. So the Aetna I’m getting at $52 for the rest of the year, reflects anactual plan premium of $72 a month.
Other than Aetna Silverscript Plus, there were some AARP plans and Humana plans which covered pods. I don’t have the list in front of me but it’s on the page somewhere.
My pods are supposed to be $10 per month but again this is on a special financial assistance plan. My husband has cancer so we qualify for extra help.
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Dexcom is part B under Medicare-covered at 80% or 100% depending on your part B supplemental coverage.
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@CJ114, thanks. It is a big relief that Dexcom is part B. I assumed that it would be part D because it is distributed through the pharmacy channel. I have to stop trying to make sense out of Medicare rules.
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Last year I had to set my husband’s Medicare up and this year it’s my turn. I’ve had it. It wore me out!
Call a Medicare consultant, they will do this work for free and they have all the information. Nothing we say can account for all the possibilities. If you do not know one, (who does), contact your local stat agency for help in finding a consultant.
I believe in Florida this is their web site.
https://www.floridashine.org/Home.aspx
If not I image they will at the very least help you find the correct place.
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No choice in that Omnipod got the okay for Medicare to be under Part D. Your insulin for it will be under Part D too. From what I understand Omnipod has no plans to change that. Other tubed pumps fall under Part B and the insulin for pumps fall under Part B. Dexcom got their okay under Part B as DME.
At the beginning I would suggest searching a GAP insurance out. You can go on the Medicare site and put in what you want covered and it will tell you what plans cover it. You will also want to investigate the donut hole.
I don’t recommend Advantage plans unless you are on a budget. They cut costs so they can be cheaper and it isn’t always to our benefit. But it is usually cheaper and that can be very important for some. And if you don’t get GAP at the beginning I think it’s pretty hard to get it later. If you go with an advantage plan there can also be penalties to go back to regular Medicare Part D. I think the penalty is decided by how long you didn’t have Part D. That is covered under the link of your coverage options. I am not an expert on Medicare, and you need to research everything yourself!
It can be very confusing trying to pick what you should sign up for. There are agents that can help you with the process.
https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/your-coverage-options
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@Rphil2, thanks for the Florida link. I will contact them. My workplace gave me access to a Medicare advisor. I sent him a list of my prescriptions and told him that my most critical supplies are OmniPod and Dexcom. A couple days later we had a video chat. He explained that he could not find OmniPod and Dexcom and I would therefore have to pay out-of-pocket. He recommended an Advantage plan because my other pills are cheap and it would save me a lot of money. I know enough to classify this as bad advice. This is why I posted on this forum. @Terry4 posted a link to a Medigap vs Advantage plan video earlier this week. This video was extremely helpful. I now understand why the free lunch is not free. It never made any sense to me that a Medigap plan costs money, a Part D plan costs money, but if you combine the two and call the combination Advantage plan that it is free. My intention is to go with the AARP Medicap Plan G unless I learn something new.
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@Marie20, thanks for sharing your preference and reasoning for GAP insurance. I will go with GAP insurance unless I come across some unexpected information. Otherwise I am done with this part of my quest and I will sign up for AARP Plan G as soon as I get my Medicare number. Not having my Medicare number is holding me back. To create a medicare.gov account and do the research there I need a Medicare number. I have the link to the Insulet Medicare page which lists all the companies that cover OmniPod under Part D. I will definitely contact them all. I am interested in the advice from OmniPod users on Part D because I envision that the messaging from an insurance company salesperson is different from that of customers with expensive claims.
I wish my comment in the other thread stated things this clearly. As @artwoman pointed out in that thread, Medicare Advantage (MA) plans make liberal use of prior authorizations or PA. Unless you like insurance company staff over-ruling your doctor when it comes to medical decisions, especially life and death ones, avoid the PA-loving MA plans!
Can you imagine being diagnosed with a life-threatening disease, given a medical path of treatment by your doctor and then being told by some bureaucrat that you can’t follow your doctor’s advice because of rules?
Good for you for smelling something fishy!
Unfortunately, as @Marie20 noted, some people have little ability to make a good choice due to economics.
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@Helmut : I have Cigna Part D. It covers Omnipod and it covers both Humalog and Lyumjev with zero copay. So I pay monthly for the Part D and it provides “free” insulin for those two brands…Their formulary does not cover Fiasp or Novolog at all. So be careful to check your insulin when researching Part D plans.
As far as Omnipod, there is a copay that becomes large when I hit the part D donut hole. This year starting in about March my co pay for 15 pods was $220+/-. I searched last year but was unable to find a Part D with lower copay for the pods.
Dexcom via Part B is great with a Medigap supplement to cover the copay. I get Dexcom supplies for 0 copay for most of the year thanks to the Medigap coverage. I am guessing that a switch away from Omnipod to a tubed pump would save me from that Part D copay but have not confirmed this yet.
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@John58, thanks. This is very interesting to me because I am currently with Cigna. Staying with Cigna might make the switch easier. I currently use Humalog because this is the only insulin that Cigna paid for. I liked Novolog much better. I will look around and see whether there is a plan that gives me both at a reasonable cost.
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If you are looking to compare plans that cover Eli Lilly Insulins such as Humalog, the following is a great tool to help save you time.
The Medicare.gov site is always more up to date and has additional plans that will tell you who covers all of your part D drugs but this is a good starting point of the major players
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@CJ114, thanks. I had no idea that there were so many Part D plans even from the same insurance company. Is there anything similar for Novolog?
I believe this is what you are looking for. I would check out Wellcare first as they tend to have great drug prices on their formulary and their plan rates are dirt cheap. I have used them for years but imported my Humalog from Canada. With reduced insulin prices in the US, there are better options here now.
Ensure you do a “show all” after opening this site. Again, Medicare.gov will have additional and potentially better options.
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@CJ114. thanks. This is what I was looking for. I am still waiting for my Medicare number so that I can use Medicare.gov.
I use AARP for both my scripts and Medigap and I have been extremely satisfied. I do not use omnipod however. My Dexcom is covered under part B and if that is the case for you, the Dexcom will be fine with a medigap. plan. I believe that omnipod is covered as part D prescriptions.
One thing you did not mention is if you will remain employed after age 65? If so and your group plan is requiring you to sign up for medicare then it is likely that your current group plan will suffice for your script coverage.
I did this for a few years.
I wish you well, I know this is so difficult, at first, but once it sort of works you will think, oh yeah, I got this. I wish you well my friend.