Hello. I just started Medicare and have been Type 1 for about 12 years. I am concerned that paying for insulin pens at $35 per month for two types of insulin will be unaffordable. Would using a pump and getting insulin under part b be cheaper?? The problem is that i am petrified of the pump. I just prefer everything as uninvasive as possible. Thank you all.
2 Likes
Well, Iāve never been afraid of shots, or having something invasive on my body, but I can tell you that it was easier for me, when I went on the pump, to insert a site once every 3 to 3 1/2 days than having to give myself a shot at least 4-5 times a day. That felt way more invasive, and I also didnāt get such great results with MDI. But everyone is different.
5 Likes
I have just gone on Medicare and I just started on the Omnipod. The pricing is different with Omnipod. It comes out to be $45 a month for me with insulin. I donāt know if thatās too much for you. I get the pods and the insulin through Part D.
I can address the pump vs. MDI part of it though. Itās one of the best things I have ever done for myself. Very freeing. I resisted going on a pump for years! I should have made the switch decades ago.
3 Likes
Wow!! Good to hear you actually like the pump better. I feel that the pens are easy and Iām not that bothered by them. But paying for two kinds of insulin at $35 is going to be a lot when Medicare starts. I feel as though I may never retire because of insulin prices and paying rent. I thought insulin when using a pump fell under part B for Medicare so maybe it would be cheaper than using pens under Part D. Itās all confusing and a bit overwhelming.
1 Like
The Omnipod is treated a little different than the typical pump. They are disposable and not considered durable medical equipment. So they are covered under part D as a prescription instead of part B.
1 Like
For a T1, Medicare pays for the pump, the supplies, and the insulin. One kind of insulin does the job of both basal and bolus. If you also have supplementary insurance, it costs you nothing. Zero. Of course, you have to find a source of insulin that will bill under Medicare Part B, which might be a problem with Walgreens or CVS because they get paid less than under Part D. I went on a pump as soon as I qualified for Medicare at age 65. Previously, had done MDI and bought insulin from Canada. There is no reason to fear pumps. They are extremely freeing and as the other reply said, you substitute one insertion every 2 to 4 days for, in my case, 6 to 8 injections each day. AND insulin is always with me in the pump so I donāt have to carry anything around with me.
3 Likes
I have Medicare parts A, B and D with a gap plan (supplementary insurance). Medicare part B pays for the pump and all the supplies as well as the insulin with a $35 copay. The gap plan picks up the copay so I end up paying nothing for insulin.
I get my insulin through CVS it did take a bit for them to get it sorted out but since then they handle it correctly.
As others have said there is no reason to fear the pump. A single āinjectionā once every couple of days versus multiple daily is much easier in my mind. Plus it gives you so much more freedom. Particularly if have a CGM which is admittedly another āinjectionā but only once every 7 days. Then you always know your glucose number and management becomes so much easier.
1 Like
Hi @Jo117 If you use a pump it should be because it benefits you, not because it might cost less. If you canāt afford the $35/insulin per month or $850/year for 2 insulins please review the information for Medicare Extra Help
2 Likes
Iāve been type 1 since 2005 and on a pump since 2007. Pumps are so much better than multiple injections per day. Pump + integrated CGM = lower A1C. Pumps have come a long way since I first started and things are still improving. If you go the pump route, just make sure that it is covered by Medicare, so that the insulin will fall under part B.
2 Likes
I donāt have diabetes, but Iāve been taking care of my brother for 11 years. He was on manual injections the first two years. Heās been on the Tandem pump for 9 years. I love Tandem. Life is so much easier with Tandem. If you also get Dexcom, life is even easier. In 9 years, I can see where Tandemās insets, (cannulas), have improved. Itās easier now than it was 9 years ago. Tandemās reps are really good. Theyāre well trained & theyāre available 24/7.
1 Like
I should have made it clearer that i meant $35 per month per two different insulins. Si it would be $70 per month in total for rapid plus long lasting insulin. I findbthis pretty expensive.
1 Like
Cinderfella, would it be possible for you to share your prescription drug plan? I have been MDI for a decade, but when I went to get the omnipod approved, I was told the cost would be about $400.
1 Like
Another advantage to switching to a pump. You will no longer need a long lasting insulin.
2 Likes
I was MDI for 30 years. Didnāt like the idea of all the tubing and where to keep the pump. For me, the new Tandem Mobi with the 5ā tubing has been great
- insulin is paid by Part B so depending on your Medicare coverage there may be no out of pocket costs
- no frequent daily injections and donāt always have to make sure I have a pen with me all the time
- no long acting insulin
- Time in Range has improved significantly.
Only downside with the Mobi is if you want to use the pocket that you attach to your body to hold the pump, you will need to purchase yourself but once you figure out placement, it can be kept on for several days
Overall a great experience
1 Like
Also forgot to add CGM which really helps
I am using Advanced Diabetes Supply and if you can use Lispro, they will ship to you. So far no issues with them and they are very responsive and havenāt had to deal with Walgreens or CVS to get billed to Part B
1 Like
I have the Medex Medicare supplement plan. Medex is a Blue Cross product. That is what was offered to me as a retiree benefit when I retired from my job. I was a municipal employee for decades. The Omnipods are $75 for a 90 day supply. They make me use generic insulin though which is $20 for the 90 day supply. .
1 Like
I canāt speak to the Medicare part of this question but only to the āshould I?ā partā¦30 years ago (type 1, multiple injections & finger pricking) I was adamant about NOT being āhooked up to a machineā! It was the last thing I wanted to do then a friend said TRY IT, what have you got to lose? Well I did and have never looked back. Iām so used to tubing, stashing the pump, keeping my dog from knocking off my cgm, that I donāt regret it for a moment.
āTry it, what have you got to lose?ā As a good friend said
2 Likes
Cinderfella,
Iām on Medicare and also have the BCBS Medex plan (grandfathered into it from having worked at NE Deaconess Hospital.) Iāve never submitted my insulin through Medicare, even though it would qualify because I use a pump, but my drug plan at Medex covers a 90 day supply of Humalog at only $15, so thatās only $60 per year, and Iād much rather not have the hassle of trying to get smooth coverage through Medicare.
1 Like
Are you afraid of the physical nature of the pump catheter being inside your tissue? Or, are you afraid that you may not be able to manage the change in treatment?
1 Like
Iām afraid that Iāll hate something attached to me for 24 hours a day. Also a little afraid of being hooked up and reliant on so much technology. Maybe i should get with a diabetes educator or endocrinologist for help?
1 Like