Which Insulin Pumps Are Covered By Medicare

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Qualifying For Insulin Pump And Insulin Coverage

Individuals type 1 diabetes or other insulin-dependent conditions may qualify for an insulin pump under Medicare Part B. Medicare covers insulin pumps deemed medically necessary as part of the Durable Medical Equipment benefit (DME), which covers certain medical equipment used at home. To qualify under the Medicare Part B DME benefit, insulin pumps must be worn externally and must be deemed medically necessary by a physician. Individuals with diabetes are eligible for coverage if their glucose is difficult to control. For the most part, qualified patients suffer from type 1 diabetes, but some type 2 and gestational diabetes patients may be eligible as well. Most patients must complete a diabetes education program before qualifying for coverage. To get coverage for an insulin pump, follow these steps: Visit a physician. The doctor will evaluate a patient's glucose levels and current blood glucose maintenance regimen to determine whether she qualifies for an insulin pump. Patients must typically document a history of daily glucose testing and frequent adjustments to insulin doses to qualify. Verify medical necessity. The doctor must submit a Certificate of Medical Necessity to Medica Continue reading >>

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Popular Questions

  1. rdrandal

    Type-2 diabetes + Insulin Pump + Medicare

    About 14 years ago medication for my Type-2 diabetes could no longer control my blood-sugar levels so I began a regiment of insulin injection therapy. After several years I utilized an insulin pump for even better control. Everything was great until I retired and started Medicare. My mail-order pharmacy informed me this week that they would no longer offer my insulin if I used it in a pump. If I told them I used it only with injections they could continue to sell me the medication. WTF?
    Medicare has requested that I take a number of tests before they would allow me to purchase pump supplies even though I have my doctor's prescription for the supplies. Every test I've taken shows that my pancreas produces insulin. This is common for a Type-2 diabetic. Because my test results don't match Type-1 results Medicare refuses to pay for my pump supplies.
    Has anyone else experienced these issues with Medicare and if so…what can you do. I'd rather not go back to injections but it appears if I want any help from Medicare I'll be forced to. I always thought that good management of diabetes was important for a healthier life but apparently the government is more concerned about cost than maintaining good health in it's citizens.

  2. Type1Lou

    You only got part of the answer from your mail-order provider. Medicare does cover insulin used in a pump but it is covered under Medicare Part B. Insulin that is injected (not used in a pump) is covered under Medicare Part D (Prescriptions) I just became eligible for Medicare and researched this thoroughly since I use a pump. (Make sure your doctor's RX includes info that this insulin is used in a pump.) The good thing is that your pump's insulin costs will not be applied to any Part D "donut hole" amount. I would advise you to check the Medicare site that shows which providers are authorized to get you your insulin…there's a list of "approved Providers". Your pump manufacturer may be able to help you navigate through the Medicare approval process for a pump. I would arm myself with documentation showing any improvement in your diabetes control (A1c"s?) while using a pump if you have that. Perhaps your doctor can help provide that info? I am a Type 1 and I understand that they may need additional documentation from you as a Type 2. That might include a C-peptide test as well as your testing log book. It is FRUSTRATING to have to validate a treatment that you have been using to better manage your condition and maintain control. I just successfully battled with my Medicare Advantage provider about obtaining the pre-authorization for the test strips I use (also under Medicare Part B) since I test 8 times daily, more than is normally allowed under Medicare. I'm just about to get my pump supplies filled for the first time under Medicare and am keeping my fingers crossed that it will go smoothly. Wishing you well

  3. rdrandal

    Thank you for the information. It's important that individuals know their options when dealing with Medicare. I have Parts A, B and D but I wasn't aware costs could fall under Part-B. My AARP Part D provider suggested this particular mail-order pharmacy. Thank you again for the information. Everything helps when dealing with our government now

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