Tandem Mobi and Medicare

Is there anyone with Medicare and a Supplement (not Medicare Advantage) that has a MOBI, and are the supplies covered. Everything I read says no, because they do not consider it Durable Medical Equipment.

Thank you.

I am switching to MOBI when my T-Slim warranty expires in July. Tandem told me that Medicare covers MOBI same way it covers T-Slim. I have Medicare Plan G with UnitedHealthcare and I pay zero for supplies after my annual deductible is met. Best to call Tandem and get them to confirm with you what the costs will be in your case. Also, ask them what third party will supply you with ongoing pump and CGM supplies and contact them, ask them to tell you exactly what your insurance will cover. Document your calls! Good luck!

I’m not Medicare, but it is absolutely DME. According to their CFO, they’ve starting having the pharmacy channel discussion with a few insurance companies, but they’ve never actually expected to be successful with that. They just wanted to open lines of communication for when Sigi (their true tubeless patch pump that’s in development) is ready to launch, likely 2027. She’s reported that surprisingly a few them have actually been receptive to possibly adding Mobi to the pharmacy channel, but it’s all early discussion there are no pharmacy contracts. Only DME thus far.

Now, my understanding is that it’s not available to Medicare/Medicaid users yet, just like it’s not available to in-warranty users who want to upgrade yet. Tandem does slow rollouts, where they expand access to new products over a long time. They did their first release in February, but that was limited to people who’s insurance allows them to buy direct from Tandem. Then in April they started shipping pumps to the first few DME suppliers, Byram and CCS only to start, and they’re still adding other suppliers into the network. I was told full launch for everyone, including Medicare/Medicaid would be this summer, likely June (any day now), but possibly July.

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Hi Nan. If you have medicare part B all the supplies for an insulin pump that is classified as durable medical equipment are covered.
Here is the medicare policy on this.
LCD - External Infusion Pumps (L33794)

I can’t find anything saying Tandem has completed the paperwork to classify the Mobi as DME yet. Like @Robyn_H says, it could be any minute now. It could also be end of September or later since Tandem is waiting on medicare.

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Thank you for that. Like you and Robyn; I was told that Medicare has not approved the MOBI yet. I have been on a pump for many, many years and never pay anything for my supplies. My Tandem T-Slim warranty expires the 28th of this month. I will just need to wait to order for approval to come through.

I had wanted to switch to an Omni Pod, but it is cost prohibitive because they do not consider it DME. I actually believe it would save them money, but non DME is not one of their line items. Think about all the waste for tubing and cartridges. I am happy to stay with Tandem though.

I will keep watching here to see when approval comes.

Omnipod can be mostly covered by a medicare Part D plan then hopefully your medicare supplement plan covers the rest. Have you checked your current Part D plan’s formulary to see if it includes Omnipod?

-Chris

I have the original Medicare Part B and AARP supplemental Plan F. I am currently using Tandem t:slim X2 pump that the manufacturer warranty has been expired last year. Tandem contacted me recently for upgrading to Mobi Pump because the pump is out of warranty. In case of pump failure, I won’t have any pump to use. Anyway, they asked several questions to justify the need of upgrading to Mobi Pump. As usual, they need to obtain documentation from the endo and it will take 2 to 6 weeks to get the Medicare approval. The new Mobi Pump supplies, infusion sets, cartridges, etc. could not be ordered until the next supply date is due. My endo just provides the documentation two days ago.

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Yes; I spent quite a bit of time on the phone with Medicare, and their DME approval department. They checked on seeing if it was possible to get an exception for Omnipod. They then advised me that while they will cover any pump supplies, Omnipod is not considered a DME because the pump part is not reusable. At this point they are still reviewing MOBI.

I have original Medicare and a Medicare Supplement. My part D pharmacy plan will cover it, but the cost is prohibitive.

With a regular pump; I pay nothing.

That’s good news that your Part D plan includes coverage for Omnipods even though it leaves you with a large copay. The next thing to check, if you haven’t already, is will your supplement plan pay the copay?

If the supplement plan doesn’t reduce the Omnipod copay enough to make it affordable the last bit of advice I’ve seen from other on this forum is to shop for a different Part D plan that covers your medications and has Omnipods for a copay your supplement plan can cover when Medicare Open Enrollment starts in October.

Yes; I have talked to both Medicare, and my part D carrier. Part D will cover a portion, but the co pay is prohibitive.

Medicare will pay nothing, and looked at considering an exception, but it is simply not covered. They do not consider Omnipod DME. They have not ruled on MOBI yet. This, as of last week. .

From years of dealing with them; I know anything new takes time for them to vet it.

Hi Nan. I’m saying you have to call your Medicare Supplement provider or read the materials they provide in order to find out how much of the copay they might cover.
-Chris

Get a medigap plan. If Medicare Part B covers your supplies. A medigap plan will cover the other 20percent.

Do any Medicare Supplement Plans cover the Part D copays in whole or in part? I don’t believe they exist. All the Supplements I found would cover the Part B copays but had nothing yo do with Part D.

The biggest expense with covering Omnipod (or anything expensive) on Medicare Part D is the donut hole coverage gap. That is when the copays skyrocket, usually kicks in mid summer for me and lasts for the remainder of the year.

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Here is a good article about Medigap aka Medicare Supplement Plans.
Best Medicare Supplement Plans Of 2024 – Forbes Health

From what I’ve read not normally but between states being able to approve supplement plans with additional coverage and company retirement benefits it’d be worth a phone call to check. That one phone call is certainly easier than than slogging through Part D plans to find coverage for your medications and Omnipods.

Is the Part D donut hole being eliminated starting 2025? Changes to Medicare Part D in 2024 and 2025 Under the Inflation Reduction Act and How Enrollees Will Benefit | KFF