@Rphil2, thanks. I’m 68, still working and covered by an excellent group plan. I gave notice and will retire at the end of the year.
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I believe we got copay caps of $35/month on the insulin under Medicare last session. The next step will be to push that limit onto private insurance policies. That will be challenging. After that gets through, the diabetics will lobby for medical device copay caps. They will prob start with Medicare, but there is no telling how long that will take. https://www.medicare.gov/coverage/insulin
That is true, but $35/month only covers certain insulins and those insulins need to be on your insurance formulary.
I am a resident of Florida, and I have OmniPod covered under Part D and Dexcom covered under Part B on my traditional Medicare plan. I cannot go on an Advantage plan because I live half the year in Wisconsin, and I really would not WANT an Advantage plan because it would not cover what I need. I pay approximately $600 for a three-month supply of my OmniPod 5, but between Medicare and my supplemental insurance, the cost of the Dexcom is covered in full.
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@SherryAnn, very interesting. Have you decided yet on a 2024 plan? Btw, I live in Naples.
Hello. Welcome to Medicare. I have UHC Medicare advantage. My Dexcom G7 is covered under PartB. I was on omnipod which is Part D. It was covered but the copay is high. I switched to MDI but have co pay for insulin and InPen. Of course Medicare will pay for insulin if you use a pump. Hard to understand the rationale as the InPen lasts a year and in my opinion would be part B. Oh well. My advice is to investigate plans before deciding. This months AARP has a great article on Medicare.
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We will stay with the traditional Medicare plan that we have had for the past six years. Along with our supplemental plan, we are happy with the coverage and can afford the $2400/year for the Pods and the premiums for the Medicare plans. My husband and I live a bit further north than you in Pinellas County.
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This is from the Insulet web site regarding finding a Part D plan to cover Omnipod:
" How Help Your Patient Determine Where Omnipod is Covered on Medicare Part D?
FIRST: Go to medicare.gov or call 1-800-MEDICARE to find the plan that best covers your patient’s medications
THEN CHECK FOR OMNIPOD: Omnipod is designated as a medical device. This means that you cannot search for “Omnipod” when looking for plans. Once a plan is found that best suites the patient, click on the plan details to get the best number to call for that plan. Call to check for Omnipod coverage."
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@John58, thanks. I wish my Medicare advisor would have known what you just stated. It also means that I don’t have to wait for my Medicare number to start the OmniPod research. The pills that I need cost $5 on Amazon. Dexcom is taken care of by Medicare Part B and supplement. I started to go through the Part D plan details of companies that cover OmniPod.
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This may help too and was taken off of Omnipod website:
The Part D plans below cover Omnipod and may be the most cost-effective options for your Omnipod prescription:
Omnipod® 5 Automated Insulin Delivery System
| Plan Name | Coverage Level | Phone Number |
|---|---|---|
| Cigna – All PDP and Advantage plan offerings | Preferred | |
| Tier 3 | 855-391-2556 | |
| Humana Gold, Community, and Choice Advantage Plans | Preferred | |
| Tier 3 | 888-347-0092 | |
| Aetna SilverScriptPlus | Preferred | |
| Tier 3 | 855-335-1407 | |
| Elixir – All plan offerings | Tier 4 | 866-250-2005 |
| Wellcare – All PDP and Advantage plan offerings | Tier 4 | 866-527-0056 |
| MedImpact Medicare | Tier 4 | 877-403-6032 |
Omnipod DASH® Insulin Management System
| Plan Name | Coverage Level | Phone Number |
|---|---|---|
| AARP MedicareRx Preferred (PDP) and MedicareAdvantage | Preferred | |
| Tier 3 | 800-850-6807 | |
| AARP Medicare Advantage Plans 1, 2, 3 | Preferred | |
| Tier 3 | 800-850-6807 | |
| AARP Medicare Advantage Choice | Preferred | |
| Tier 3 | 800-850-6807 | |
| Cigna – All PDP and Advantage plan offerings | Preferred | |
| Tier 3 | 855-391-2556 | |
| Humana Gold, Community, and Choice Advantage Plans | Preferred | |
| Tier 3 | 888-347-0092 | |
| Aetna SilverScriptPlus | Preferred | |
| Tier 3 | 855-335-1407 | |
| Elixir – All plan offerings | Tier 4 | 866-250-2005 |
| Wellcare – All PDP and Advantage plan offerings | Tier 4 | 866-527-0056 |
| MedImpact Medicare | Tier 4 | 877-403-6032 |
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@CJ114, thanks. Would be nice if OmniPod was included in the medicare.gov plan comparison. I went to the websites of a couple of these companies and they actually have the prices that I need online. I like a written fee schedule much better than a quote over the phone. It is often hit-or-miss with customer service representatives.
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BEWARE - Always get a final quote in writing by the carrier before taking on any plan. I have had Medicare.gov come up with pricing with their tool and when I contact the insurance company the costs are higher, not by much, but higher. Websites post prices but the healthcare business is so fluid, prices can change and website updates may not always be in sync.
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@CJ114, I did not think of that possibility. Thanks for warning. I will do that.
Here in New Zealand Omnipod is not available at all. But my T:slim x2, insulin and all of my diabetes prescriptions insisting insulin are completely free. No parts A B C D 
I do have to pay out of pocket for Dexcom @about $400/month. it is scheduled to be covered sometime in 2024 at which point it will (finally) be free. That will be a huge relief.
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Under our Part D medical coverage with original medicare, the deductible is $505 this year which make the cost for an omnipod over $700 for the first month and then using the 47% formula $505 for every month thereafter. Is there any less expensive way to purchase an Omnipod? Please let me know. I would really like to try this - still using insulin pens and a G6. Folks, if you have any workarounds, I’d be delighted if you can share. We use Wellcare.
Yeah, that’s been an issue. People have been asking me about that because they use something off formulary. I don’t know how common that is. Mine price dropped through their voluntary actions. We should poll somewhere on the site.
The big problem with both Dexcom an Omnipod is they are not listed in with normal prescriptions when you try to look them up. Even the experts often have a hard time finding them. I got started at this phone number: 877-939-4384 OmnipodMedicare Access Team. For me they recommended United Healthcare AARP plan for part D.
@Terri2, I went with United Healthcare AARP part D for OmniPod and Novolog. Dexcom is easier since it is covered under part B. I am getting my G7 through USMed.
CJ114. Interesting to note while I was getting my G6’s from a supplier in Arizona I wanted to fire them because the started after the pandemic no shipping an extra sensor. To cover shipping time lags . According to them SS. Would only allow them to ship every 90 days. This left me several times without a sensor. And sense I tend to become hypo over night I wasn’t gettin any sleep waking up to test my blood.
I friend of mine asked me way I wasn’t getting my sensors from the V.A. Guess what, no co-pay. Save me a lot of money on Soc. Security.
The other trouble I have with them is the will not approve an insulin pump for me. Epeptide level is to high… I wanted to get the new Tandem Mobi. It requires far less insulin on board the other pumps