Medicare and T1 care

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JanEW posted on Thu, Apr 12 2012 11:17 AM

I will turn 65 in 3 weeks.  I became a 50 yr. medalist in 2009.  As a teacher for 31 years I always had excellent medical care with the group insurance I was offered.  At retirement I was able to continue with that insurance.  I have used insulin pumps and insulin pens since 1984.

Today I found out that Medicare will not support my Omnipod insulin pump.  Nor will my Plan D provide insulin cartridges for a pen.

So...the only thing supported when I turn 65 is insulin syringes and vials of insulin??  It seems so antiquated.  I haven't used a syringe since I was 37 years old. 

I have been in excellent health with a bare minimum of complications.  I take care of myself.  But now I am scared.  I love the Omnipod.  It gives me such freedom and ease of management.

Does anyone on Medicare have a suggestion?  I hope so.  Thanks.

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Simi_Papa replied on Thu, Apr 12 2012 2:18 PM

Maybe you need to look around for a different plan D (drug plan).  Mine covered Levemir pens.  Does you retirement medical plan go away when you are eligible for Medicare or does it supplement Medicare?  Also look at medicare Advantage plans that have built-in drug plans.  The cost of the Advantage plans varies from the same as Medicare to an additional $100 or so a month and you might find a plan that will cover your requirements.


"May the Force be with you!"

Diagnosed in 1997; Off all meds except Metformin!! Smile

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ShirlB replied on Thu, Sep 6 2012 5:22 PM

Jan - I became a medalist in July 2007 - Type 1 since age 5 in 1954 (now 58 years with Type 1).  I am on Medicare A&B and have been because of a Type 1 complication, CAD disease (3 heart attacks, 5 by-pass surgery, etc.).     Medicare Part B - durable medical equipment - will pay for an insulin pump, just not the OmniPod.  I have used an Animas pump since 2005 (Animas 1250 - 2005; Animas PING - 2010).   Medicare will pay for a new pump every 5 years.  Under Part B (not Part D) my insulin is also covered as well as all my pump supplies and test strips (average 9 per day).    I also have a supplement with BlueCross/Blue Shield so the 20% that Medicare doesn't pay is taken care of by my supplement.  I just joined the message boards and I hope by now you have been able to find some other answers to help you with this.    The OnmiPod sound nice but I love having my Animas Pump.   Take care / Shirl

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Tor replied on Fri, Sep 14 2012 4:48 AM

Hi Bill

Hope you are doing well.



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tomjef replied on Fri, Sep 14 2012 7:36 PM

Hi Jan, I've been using a pump (4)  for 17 years, and have been T1 for almost 70 years, so I have a 50-Year Medal, and I'm on Medicare. I think Medicare's problem with the OmniPod is that, to them, changing the pod every 3 days doesn't fit with their limitation of one new pump every 5 years. I've been using my current pump, Animas Ping, for 2 years, so it will be at least 3 more years before Medicare will get me a new pump. I'm pretty sure Medicare allows almost any other pump (including Tandem tSlim) except for OmniPod, as long as they haven't approved a pump for you for at least 5 years. And I think this means if you already have a pump when starting medicare, they don't really care how long you've had your pump when you order your first one under Medicare.



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bjkiah replied on Sun, Jan 20 2013 9:30 PM

Jan, Medicare will not pay for Omipod, which you know but one way around would be to get another kind of pump. I am now 70 and have been pumping for 13 year. Also with another type of pump you will be able to get your insulin through your Part B of Medicare that way you won't use most of you Part D allotment for insulin. You're allowed to use Part B because when you have a pump the insulin is considered Durable Equipemt like your pump. I hope this information will be helpful to you.

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lots of options - send me back  a reply if they haven't heped you yet.   

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Any idea how to find out from 25 and 50 lists who has longest pump usage?   I know a few people who started back when I did, but I also know that these things were around for a few years of testing and usage prior to the "release" of the (almost) working models


My first pump was an AutoSyringe*6 --  one basal rate which was "set" by diluting the lilly U40 insulin with saline (which caused it to precipitate) and later with the specific insulin manufacturer saline they manufactured for medical use in diluting the U40 stuff for younger children...

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