Page 55 - Appendices for Patti's Evaluation
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7/21/2020 Medicare and Type 1 Diabetes - JDRF
5. Coverage of insulin pumps and arti icial pancreas
systems under Medicare
Medicare covers tubed insulin pumps under its “durable medical equipment”
(DME) bene it. There are speci ic medical eligibility criteria that must be met in
order for such coverage to be given.
Medicare has announced that Part D plans may choose to cover patch pumps.
There is one patch pump on the market now (the Omnipod) and there are several
in development. It is not clear whether Part D plans will cover all such pumps as
they come onto the market, just a single patch pump, or none.
Medicare bene iciaries wanting coverage for a patch pump should check with any
Part D plan they are considering joining, before doing so, in order to verify that
the plan covers patch pumps.
Medicare also does not yet extend coverage to the one FDA-approved “arti icial
pancreas” or hybrid closed-loop system on the market (the MiniMed 670G).
Key Takeaways
If you use a tubed insulin pump and have a Medigap policy, there will likely be
no charge for the insulin used in that pump other than the monthly premiums
you pay for Part B and the Medigap policy.
It is critical to purchase a Medigap policy during a time when you won’t be
denied or charged higher prices based on your health. Learn when those
times are as some are once-in-a-lifetime occurrences.
Medicare currently covers three CGMs: the Dexcom G5, G6, and the Abbott
FreeStyle Libre. You may use a smart device in conjunction with your CGM
receiver.
Medicare Part D plans may cover the Omnipod. Insulin used in a disposable
patch pump such as the Omnipod will be covered under Part D. Medigap will
not cover cost-sharing under Part D.
Medicare does not currently cover arti icial pancreas systems.
https://www.jdrf.org/t1d-resources/living-with-t1d/insurance/medicare/#section4 8/9
