Omnipod and Medicare

Hi there:
I am 71, live in Texas (still an LA girl at heart) and have a Medicare Advantage program (PHC) an HMO. My new Endo did testing and didn't like my 8.1 A1c so suggested a pump. She gave me the Medtronic folder and said to fill out the paperwork. I'm a former programmer and tech writer so research is the name of my game. I chose the Omnipod and filled out the online request for coverage. The rep called and said that Edgemark (or park?) and Kenny was my contact. It took Kenny 2 weeks to contact me (overloaded from new pods)so I filled out Medtronic insurance request online as well. Medtronic called and said that Medicare won't cover Omnipod so I sighed and said OK, let's get this started. Then she said I had to have retests for creatine (to high as not done fasting) and assured me they could manipulate requirements so I would qualify. sounding skettchy . No sooner did I hang up when Kenny called with news that I was approved, no tests needed and my Advantage program was 'supplemental' and $100 for PDM AND $60 FOR 10 PAC!! He even sent me an email to confirm. My Omnipod rep called to see if Kenny had called me and I told her the whole ugly story. She called Medtronic and they told her that I was wearing a Medtronic pump and was not eligible for an Omnipod because it was still in warranty. Definite 'lack of truth' here. I am awaiting arrival of my pod and can't get trained for two weeks, so I will have questions, need advice, and will keep you posted on my adventures in Pumpland.


I am so glad to hear that medicare is covering your Omnipod!! Last I heard is they didn't cover them at all. I'm in Michigan, hope all coverage is the same. I have a few years yet before medicare but have been on the Omnipod for several years and wasn't looking forward to starting with something new. The Omnipod reps are pretty good and I hope they can get this all sorted out for you. When I was shopping I found Medtronic to be a bit pushy and "overly confident" that I was going with them. Good luck! Any more information about what medicare coverage you're on would be really helpful.

Love my pod and if possible will never switch to tubing.

For 2 years I paid for the pods out of pocket. I had AARP secure horizons as my medicare advantage plan. They followed medicare. Then I switched to Medicare Blue of SW FL. (Blue cross/blue shield) THEY don’t follow Medicare guidelines! I am covered! My copayment is 15%. I pay $90+ for a 3 mo supply of pods …PDM I had gotten previously. Long story. I also found getting the pods from Insulet, a little cheaper than from Edgepark.
I LOVE my Omni pod! Good luck to you!

Friends: Here is an update to my quest for answers: My PODS are to be delivered today by COB and will include 50 test strips, giving me time to clear up if my Endo must initiate orders to my 'approved' provider (One Source). Also called my Phys. Health Choice Medicare Advantage office and my insulin will fall under rules of Part B, so I'm on the hook for 20% of cost. Naturally I am hoping to use the least expensive (Apridia) but will do whatever it takes. It will hurt financially to not use up the last NEW 20ml Humulin R 500, but at $700 a bottle, forget about it. When it is time to select new plans or stick with current plans, around Nov or Dec. I will have to carefully evaluate costs and coverage. Who knows if the Advantage plans will even exist and in what form for 2014. I will also check my Homeowners insurance re coverage for loss and damage.