Paying for insulin with Medicare


#1

Close to retirement age? Not to worry! Medicare pays for insulin as long as it is used with an insulin pump. No insulin pump? Medicare will lease one for you and then you will own it at the end of the lease period.

I have always felt there was a great inequity in providing free insulin for those with a pump (under Medicare Plan B when insulin is used with medical equipment).

Frankly, I think that Medicare should be well funded and extended to all. It is an existing program that works well. The only problem with it presently is that it is not adequately funded.

Health coverage should never be a profit center for private corporations!


One Family, Three T1 Kids, Cost of Insulin
#2

I have never used a pump. Not sure I want to be forced to change when I’m 65


#3

I never used a pump either. Was happy with MDI and buying insulin from Canada until at age 69 costs were getting sky high. It was my decision. It was an option that I decided to take. Now I am on my second pump and in my 8th year of pumping. Unhappily, my choice of both pumps was an Animas Ping. Unhappily, because of Animas being put out of business, not because of the pump itself. Very happy with the pump. Happy with the fact that Medicare and my supplemental insurance paid for it and the supplies and insulin I use in it. It really was my only option.


#5

You don’t use long acting insulin in the pump - so nice try


#8

The doc is not going to write a script for the wrong insulin on a continuous basis and medicare will not pay it

so nice try twice

the script is written for the pump


#10

I doubt you are going to get that on a continuous basis - with a pump failure you could still use the novolog - it would take nothing to get the right script -

You say he could write it for a year - true but - who is going to pay?

tough enough getting it let alone backup


#11

So everyone that goes on Medicare is forced to switch to a pump?

None of it makes any sense. Why switch a person who has had 40 years of successful blood sugar control doing things a certain way. It sounds like a prescription for disaster.


#12

No you do not need to go on a pump

insulin is free if you are on a pump with medicare after a little hoop jumping

my wife gets it


#13

Even if “The doctor doesn’t monitor how many times you refill it. If a script is refillable, it can be refilled.” , Medicare sure does! A back up RX has to have the same instructive dose and time requirements as any other RX. It would be only a matter of time before someone at some office realized the re-order of an insulin that isn’t used in the prescribed delivery method has more refill than the one that does. And Medicare is very savvy with creative RX orders. Best not to red flag yourself, or your doc!

A T1 must have insulin, so Medicare will cover one or both. Check with your own coverage and plan(s). I don’t think you are forced to use a pump.

Back to the OP Topic - Just imagine having to pay for your vials, the Rapid, AND the Basal. When I had to pay for mine way back when, it was $15.00 for each of R and NPH. At least those are still cheap!


#14

Yes, cheap and don’t require a prescription. But they are difficult to use and require that one eat to the insulin. I couldn’t imagine managing three children’s diabetes with R and NPH today!

BTW, I’m sorry I somehow caused the above verbal exchange! Did not mean to start anything controversial. It was simply my workaround the problem.


#15

Nothing started - all is good

Me and Eddie was just funin


#16

I’d do it to keep them alive, but then I’d go broke for the cost of the testing strips. Diabetes is a condition that is becoming epidemic. I’m sad that we are a Market and it keeps growing as does the cost.


#17

So why are we sitting on our hands and allowing health care to be politicized? The U.S. is probably the last first world country that has NO national health care. We keep pointing out the deficits of the British system, the Canadian system and others. Why don’t we do one better?


#18

I keep asking my state and senate leaders this same question and offering the real cost in the form of life, limb, and bank. So I am not sitting on my hands!


#19

The US government has one goal - take over the planet by any means possible - that leaves no money for healthcare - they could care less about the health of the citizens.

I know a girl in Canada with severe MS - the country spends a fortune on her without blinking an eye - she loves it.


#21

You should be able to get long-acting insulin through Medicare Part D, right? Though there is an additional premium and cost-sharing with part D. Might be cheaper to buy it from Mark’s Marine pharmacy in Canada.


#22

My understanding is that insulin for non pump users is covered, under Part D.

So your complaint is really about how it is covered?. I am not on Medicare, but assumed most people who are get a part D plan to cover drugs, including insulin.


#23

The Medicare Part D co-pay for insulin can be obscene. I’m about to order my second quarter supply of Humalog and Levemir (vials) and I expect my out of pocket co-pay to run me about $1,200.00


#24

There are some strange rules with Medicare Part D. There’s a coverage gap at a certain point at which time their cost-sharing increases substantially until the catastrophic limit is reached.

https://www.medicare.gov/part-d/costs/coverage-gap/part-d-coverage-gap.html

Part B doesn’t have this.


#25

Thanks for the explanation, that is obscene. I have several years before MC but I guess that’s a good reason to stay on my pump.