What is The Medicare Coverage for Insulin Pumps?

What is Medicare’s insulin pump coverage?

Medicare breaks insulin pumps into two main types: tubed and tubeless. The type of insulin pump you use will determine how much Medicare pays.

Medicare Part B is the portion of Medicare that covers a tubed insulin pump. Part B typically covers doctor’s office visits and durable medical equipment, such as wheelchairs or crutches. Medicare considers an insulin pump a piece of durable medical equipment.

You must meet certain requirements for a doctor to prescribe the pump. Examples of these requirements include:

• using insulin to control your diabetes
• requiring frequent adjustments and dosages to your insulin regimen
• needing to check your blood sugar at least four times a day

Medicare Part B also covers the costs of the insulin that tubed pumps use.

If you have original Medicare (parts A and B), you’ll pay 20 percent of the Medicare-approved amount for the insulin pump. The Part B deductible applies. Medicare will pay the remaining 80 percent of the insulin pump’s cost.

Some people opt for a tubeless insulin pump instead. These are newer devices than tubed insulin pumps.

With a tubeless pump, you wear a patch that usually contains several hundred units of insulin. The patch typically works with a smart device to monitor blood sugar levels and deliver insulin.

Medicare Part D is the portion of Medicare responsible for covering tubeless insulin pumps.

Part D provides prescription drug coverage. You select a Medicare Part D plan from a private insurance company. Some plans cover tubeless insulin pumps, but not all do.

Part D plans have a list of covered medications, called a formulary. Often, plans don’t include the tubeless insulin pump on their formulary. You’ll likely have to call your plan to find out if it covers the tubeless insulin pump.

How much do insulin pumps cost?

In a 2019 study of 241 adults with Medicare and type 1 diabetes who used insulin pumps, 24 percent described the cost of the insulin pump as a challenge. Another 29 percent cited the cost of insulin pump supplies as a challenge.

• tubing
• infusion set
• batteries
• alcohol wipes

According to a 2018 article in Modern Healthcare, the Omnipod tubeless insulin pump may cost as much as $3,000 to $4,000 per month. Both of these costs are before Medicare pays a portion.

Insulin pump costs can vary by manufacturer and model. Some may have more expensive options, such as a touchscreen, waterproof casing, or a larger insulin reservoir.

Which Medicare plans may be best for you if you know you need an insulin pump?

If you’re thinking about how an insulin pump may improve your diabetes management, consider the following coverage information about each part of Medicare.

Part A

Medicare Part A is the first part of original Medicare. It’s the Medicare portion that provides hospital and rehabilitation care.

Medicare Part A may help pay for your hospital stay if you have a diabetes- related medical event, but it isn’t usually involved in coverage for insulin pumps and insulin.

Part B

Medicare Part B covers a portion of an insulin pump and the insulin costs, as long as your doctor prescribes it and it meets Medicare’s requirements.

Part C

Medicare Part C, or Medicare Advantage, is an alternative to traditional Medicare. It’s when you receive your Medicare benefits through a private insurer that contracts with Medicare.

Many Medicare Advantage plans offer additional coverage compared to traditional Medicare, such as vision, dental, or hearing benefits.

Medicare Advantage plans vary by region, and there are numerous options across the country. Some Medicare Advantage plans are geared toward those with a specific medical condition, such as diabetes.

It’s important to read a Medicare Advantage plan carefully before purchasing it in order to find out if it covers different types of insulin pumps and how much you might expect to pay.

Part D

Part D is the portion of Medicare that pays for medications. For most people with diabetes, Medicare Part D is the part of Medicare that helps pay for insulin and oral medications.

But it’s important to note that Part D doesn’t pay for the insulin in a tubed insulin pump — Part B does. Part D may pay for insulin in a patch pump, though, if your plan covers that pump type.

Medigap

Medigap is a Medicare supplemental insurance policy for people with original Medicare. Medicare standardizes these policies.

If you choose to get a Medigap policy, it can help you pay for out-of-pocket costs related to the purchase of an insulin pump. Examples include coinsurance and copayments.

Some Medigap plans cover only a portion of these costs, whereas others cover the entire cost. It depends on the Medigap plan you choose.

How do insulin pumps work?

When you have diabetes, your body either doesn’t produce insulin (type 1 diabetes) or doesn’t properly produce it or use it to help keep your blood sugar at an expected level (type 2 diabetes).

As a result, you may need extra insulin to maintain your blood sugar and prevent negative effects, such as nerve damage, that can result from blood sugar that’s too high.

Insulin pumps deliver a continuous or sometimes bolus (all at once) dose of insulin to help you better regulate your blood sugar levels. You wear the pump outside your body, and a portion of the pump transfers insulin from the pump to an insert in your subcutaneous (outer layer) of tissue. In this way, it delivers insulin into your body.

Tubed pumps have a small tube or tubes that extend from the insulin in the pump to deliver the insulin to you. Patch pumps don’t have tubes, so that means fewer connections.

Currently only one patch pump, called the Omnipod, is on the market, though several companies are developing other versions. Some Medicare Part D plans cover the Omnipod.

Insulin pumps are a little different from a continuous glucose monitor (which Medicare also may cover if you meet the requirements).

You wear a continuous glucose monitor outside your body, too, but it doesn’t necessarily deliver insulin for you. A continuous glucose monitor will tell you what your blood sugar is in real time, so you can know how much insulin you need or if your blood sugar is getting low.

Diabetes can be a costly disease. Managing it and preventing complications is vital and ultimately serves as a cost savings. The following are some other ways you can save money on your diabetes treatments:

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