Page 4 - Cover Letter and Evaluation for Patti Messerschmitt

If your insulin pump is not covered by Medicare, then you will pay for the pump without
insurance, but you may get your insulin through Part D.

Determining whether your insulin pump is covered by Part B

I have been unable to find out whether the Medtronic MiniMed Paradigm pump is covered by
Medicare (if it is, it would be covered by Part B). According to a paper from the Juvenile
Diabetes Research Foundation (JDRF) in Appendix D1, Medicare has not yet extended coverage
to the MiniMed 670G hybrid closed-loop system -- but that may not be the same pump that
you are using. Also, the JDRF paper is two years old, and it may not be accurate today.

Probably the best way to find out if your pump will be covered by Medicare is to talk with your
physician, who should know. And as mentioned, if it is covered, then your insulin will also be
covered by Part B and you will not have any co-payments after your annual Part B deductible
has been paid. Your doctor will likely be able to answer this question by phone or by FAX.

If your insulin pump is covered by Part B, then I can send you some more info about durable
medical equipment and the few rules you will need to follow. In some parts of the country,
Medicare designates DME suppliers that you will need to get your insulin pump from when you
need a new pump. In other areas of the country, though, you can choose whom to buy your
equipment from. Your physician and/or pharmacy should know the requirements in your area.
It’s important to get DME from a supplier or pharmacy that accepts Medicare-approved rates.

Rx Drug Plan Coverage

Until we know whether your pump will be covered by Medicare, there’s no way to know for
sure which is the lowest cost prescription drug plan for the drugs you take. If the pump and the
insulin will be covered by Medicare, then the lowest-cost plan for your other three drugs is the
Wellcare Wellness Rx Plan. If you get your prescriptions filled at a Costco pharmacy, your costs
for the last four months of this year will be your monthly premiums of $13.70, or $54.80 total.
You won’t have any co-payments for your three drugs.

Still, the Wellcare Wellness Rx Plan may not be the lowest-cost plan for your Rx drugs if your
insulin pump is not covered by Part B. In that case I will do another drug plan search that
includes insulin. At that point I’ll need some more information about the specific type of insulin
you take – but there’s no need to do that unless you find that the insulin pump will not be
covered by Medicare.

Estimating Your Costs

Your Part B premiums will be $144.60 a month. Since you have not started receiving Social
Security benefits, you will pay your Part B premiums on a quarterly basis until you your Social
Security payments start. At that point the Part B premium will be deducted each month from
your Social Security payment. But until then you will receive a quarterly bill from Social Security

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