FUDiabetes

Medicare coverage of insulin supplies and Omnipod

Found this link on DiabetesMine this morning:

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Wow. Tell me that is not the most carefully worded letter so as to provide the greatest degree of ambiguity possible?

The CMS determination that the Omnipod will not be covered as DME (Medicare Part B) is in the link below.

So this recent guidance letter (above post by @CatLady) from CMS says that even though the Omnipod is not allowed under Part B, it “may” be allowed under Part D. I don’t understand everything associated Medicare (it seems really confusing) but “Part D” (as I understand it) is both optional as well as (potentially) substantially different in coverage based on how it is obtained? As well, if you have “Part C” that may interact with “Part D” in various ways?

Which sounds like it is very possible that for one particular person on Medicare, they may indeed now be able to get Omnipods covered by insurance whereas for another person on Medicare they may not be able to do the same?

https://www.hhs.gov/sites/default/files/static/dab/decisions/council-decisions/m-15-582.pdf

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I concur in your analysis. Interesting that Part D providers have the option to include it in their formulary but are not required to do so. Gah!

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I suppose the good news is that you can shop around and find out which Part D plan covers the pump/drugs you want.

I wonder why a Part D plan would be willing to cover Omnipod when a Medtronic pump is available through Part B. Makes me wonder if there will be any Part D plans that voluntarily cover it.

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My plan is to keep working until I die so that I don’t have to deal with all of this.

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