My ex-employer is changing to Humana Medicare Advantage for retiree insurance. Do they cover Dexcom G6 and Omnipod 5 or Omnipod Dash? Also, are they pharmacy benefits or medical benefits?
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Yes I had Humana Medicare Advantage in the first part of this year. Omnipod 5 was covered as pharmacy benefit and was subject to the coverage gap and high co pays. If I remember right my co pay was over $200 per 3 boxes of pods.
The Humana Med Advantage plan I had might be different from your new one though. Mine was “Gold Plus HMO”.
There’s no escaping the coverage gap, I switched to a Part D prescrip plan and have the same high co pays.
Sometimes an employer specific plan has different rules even if plan name is the same. Can you check your plan documentation for a rep phone # specific to your employer plan?
If the basic care is medicare then yes it is covered.
Omnipod is not covered under basic Medicare , which is Part A.
Omnipod is not covered as durable medical equipment under the optional Medicare Part B.
IF you qualify for a CGM as medically necessary under Medicare’s rules- then Omnipod is covered under a Part D Drug Supplement or a Medicare Advantage Plan. You can go to the plan and look it up in the formulary, where it may be in one of the higher tiers.
Keep in mind that it is much harder to switch from a Medicare Advantage plan back to original Medicare with a Part D Supplement than vice-versa.