Omnipod - best medicare part d plan

I am looking at getting an Omnipod on Medicare. Can anyone suggest a Part D plan with low copay for pods?

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Hi. Pods are under part B. DME (durable medical equipment). I usually get a 3 month supply for around $450. It all depends on what time in the year I get them. Of course we have to meet that deductable first. :sweat_smile:

Hi - Thanks for your reply. I have been on a tubed pump on Medicare for 5 years through Part B. The Omnipod site and Medicare say that tubeless pumps are through Part D - Pharmacy. Right now that’s how it is, anyway. It must have changed.

Here is info from Omnipod, listing specific plans.

I’ve already seen this. I’m looking for someone who is actually doing it.

I just started a Medicare Advantage plan (Humana) that covers the Dash pods as pharmacy. $47 co pay for 15 Dash pods.
The best thing about it is I don’t have to deal with DME suppliers to get refills, it is handled at the pharmacy.

I am no Medicare expert but ended up picking this Med Advantage plan because I gave up looking for a Part D that would cover pods plus Fiasp and Lantus.

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Mine go through part B. That is how my Medicare statement shows it.

Thanks for the info. I can’t be on an Advantage plan - I go to a nephrologist who is out of state. I’ve been seeing him for 25 years, I have a supplement and a pharmacy plan now that doesn’t cover pods. That’s why I need anew one. ugh

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It appears that newer version Dash pods are covered as pharmacy (if on formulary), and older ones as DME.

I didn’t know that. Thanks.

I just waded through my Medicare Part D formulary for insulin prices so I looked up my plan’s price for Omnipod. My Cigna Secure Rx PDP copay for Omnipod Dash is $99 for a preferred mail order 90-day supply. This is the price if you live in my state, but it looks like the other states are similar. If memory serves, I pay about $35/month premium for this plan.

I just switched to this Medicare Part D Cigna plan in 2022 and my initial experience has been favorable.

Here’s the link to the publication if you want to get into all the details. It will tax your patience but you can figure it out. They make it complicated so that it discourages the efforts of a rational consumer!

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Last fall, during the Medicare open enrollment period, I wanted to look at my current Part D plan and see how it compared to others. I found that with all the moving parts, it was hard to do an apples-to-apples comparison.

I called my state’s (Oregon) Senior Health Insurance Benefits Assistance (SHIBA) helpline and made an appointment for a volunteer counselor to call me back and help with my selection.

About a week later the counselor called back and had me log into the Medicare.gov website and use the tool that Medicare put there to help with exactly the analysis that I wanted to do. She walked me through the step by step process. I did put in all the meds I was taking so that these comparisons were particular to my anticipated drug needs for 2022.

What I discovered is that a Cigna plan, while about $20 more per month in premium costs, the total projected cost for the year was much less than the cheaper premium plan I was using in 2021.

What I learned from this process is that anyone with these kind of questions should consult with their state agency that can help you. Every state has an equivalent agency like this. In some states, the acronym SHINE is used. This is independent advice with no embedded conflicts of interest like those present when working with an insurance broker.

I’m glad I did this and it left me confident that I’m getting the best deal possible for my drugs.

By the way, @John58, my current plan covers Omnipod Dash and Lantus but no Fiasp. It does offer Lyumjev, however.

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Agree 100%, comparing these plans is a very confusing and time consuming process. The other variables impossible to predict are whether various doctors or specialists will stay in network or move around, retire, etc. and whether pharmacy formularies will change over the course of the year (my former private insurance did that constantly).

I am calling this Medicare Advantage plan an experiment. I am trying it out this year and seeing how well they do with meeting all of my needs. There is a first year opt out (I am in my first year of medicare) that is available to me if I want to switch over to a Supplement plan and Part D mid year. So far I am quite happy with the Medicare Advantage although my first Dexcom order (DME) has been a slow process with a new DME supplier and pre-authorization, etc.

I don’t know the details of your plan. Are you aware that while you may be able to switch back from a Medicare Advantage Plan you may have to go through medical underwriting when you try to return to a supplement plan?

I understand that anyone can switch from a Medicare Advantage Plan back into traditional Medicare but the Medicare Supplement insurance plan does not have to take you back without underwriting. I don’t believe that any private insurance company will permit an insulin dependent diabetic back into their plan or if they do, they will charge a lot more for that.

This is what I referred to:
Medigap & Medicare Advantage Plans | Medicare

" If you join a Medicare Advantage Plan for the first time, and you aren’t happy with the plan, you’ll have special rights under federal law to buy a Medigap policy. You have these rights if you return to Original Medicare within 12 months of joining.

  • If you had a Medigap policy before you joined, you may be able to get the same policy back if the company still sells it. If it isn’t available, you can buy another Medigap policy.

  • The Medigap policy can no longer have prescription drug coverage even if you had it before, but you may be able to join a Medicare Drug Plan (Part D)

  • If you joined a Medicare Advantage Plan when you were first eligible for Medicare, you can choose from any Medigap policy.

  • Some states provide additional special rights.

Note
If you don’t drop your Medicare Advantage Plan and return to Original Medicare within 12 months of joining, generally, you must keep your Medicare Advantage Plan for the rest of the year. You can disenroll or change plans during the Open Enrollment Period or if you qualify for a Special Enrollment Period. Depending on the type of Special Enrollment Period, you may or may not have the right to buy a Medigap policy.

From the link you posted above about your “trial right.”

I would carefully consider this option and don’t let the calendar sneak up on you! When this door shuts, you will no longer have the option to secure a Medigap policy without underwriting at a reasonable price.

I am so happy with the way that my original Medicare works with my Supplement plan. When I take delivery of my insulin (I use a pump.), pump supplies, and CGM supplies, no further action is required from me. Medicare pays 80% and the Supplement picks up the rest. No additional paperwork or mail. Everyone gets paid and I can just get on with my life! It’s simple and it works every time. And the rules don’t seem to frequently change like they do with private insurance.

Anyway, good luck with your decision!

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Hi John - I’ve been using an Omnipod Dash with only Fiasp. Am starting to think I could take about 4 units of Tresiba in the morning to help with the blood sugar spike I get overnight. Would love to find further info on this idea.
I’ve also think that transitioning to Humalog - R instead of Fiasp. In Canada here, once I open a Fiasp it has a tendency to lose effectiveness after a month or so. Have heard Humalog - R has the same profile as Fiasp.
Do you or anyone else know anything about this?
T1D for 51 yrs in April 2022. I hope your post was not dated so apologies if my question is not appropriate.
Thank you! :slightly_smiling_face:

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I think you are mixing up some terms.

Humulin R is regular insulin and it has an onset longer than any analog insulin. It was the fastest thing we could get in the 1990s

Humalog is a faster insulin similar to Fiasp but maybe a little slower.

I use Humalog in my pump and it works pretty well.

Pretty much all insulin expires after it’s been opened 2 weeks but I use it past that date.

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This shows more details on opened insulins, and varies.

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I wonder if you are thinking of Lyumjev which is the Humalog based insulin having a fast onset like Fiasp. As @Timothy said, R insulin is super slow and is active for 6-8 hours.

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