Does Medicare Cover Omnipod?

Health Compare
Sep 3, 2022

Did you know that over 14 million seniors in the United States are currently living with diabetes?

Every year, more than 1.5 million people are newly diagnosed with this disease. If you are insulin-dependent, having an insulin management system, or an insulin patch pump like Omnipod, offers many health and convenience advantages.

TIP: Use our handy plan finder to discover which plans offer coverage for insulin, insulin pumps and other diabetic supplies and compare them against your current Medicare benefits. Or pick up the phone to speak with a Licensed Sales Agent to get answers to your Medicare-related questions: 877-882-1927.

Medicare Coverage for Omnipod Insulin Patch Pump

If your healthcare provider has diagnosed you as insulin-dependent and has prescribed a wireless insulin management system like Omnipod, your Medicare benefits might cover the cost of the PDM and pods, plus at least two types of insulin. Your coverage and copayment costs depend on which Medicare prescription drug (Part D) or Medicare Advantage plan you are enrolled in and if they include Omnipod on the formulary.

Medicare’s coverage for insulin and insulin delivery methods can be a bit confusing because different parts of Medicare cover different systems. As mentioned above, if the delivery system is wireless, the system, plus your insulin, falls under Medicare Part D coverage. However, if you use a delivery system that uses a tubed insulin pump, you get your coverage from Original Medicare Part B (medical insurance) if you are eligible.

This equipment coverage falls under the Medicare Part B category of durable medical equipment (DME), and it includes insulin, pump, and supplies. To qualify for this coverage, you must get everything from a supplier of DME that accepts Medicare assignment. If your DME supplier does not supply insulin, there are many national pharmacies that are able to bill Medicare as DME suppliers. Your pharmacist can give you this information, or you can call a local CMS office and ask for details about local DME suppliers for insulin.

Omnipods and Medicare Advantage Plans

If you have a Medicare Advantage (Part C) plan through a private insurance provider, they are required to provide at least the same coverage that you would get with Original Medicare benefits, both Parts A and B. Many Part C plans also include prescription drug coverage as part of the plan.

Are you wondering if Medicare Advantage pays for the Omnipod insulin pump? If you do have this added coverage, you should check your plan’s formulary to see if Omnipod is included. If you aren’t sure, you can use an online Medicare plan finder to help you find and compare plans.

TIP: Are you looking for a plan that offers more of what you need at a price that you can afford? Then check out our 7 reasons to switch Medicare Advantage plans guide.

What is the Omnipod Insulin Patch?

The Omnipod system, created by the Insulet Corporation, is a tubeless and wireless insulin patch pump that provides a continuous supply of insulin. You have complete control of the amount of insulin and the flow rate you get through the Personal Diabetes Manager (PDM).

With the Omnipod system, you only have to fill a new pod with your insulin, place it on your body wherever you would normally inject your insulin and the cannula automatically inserts itself there. You then press start on your programmed PDM, and the insulin flow begins. You can use the PDM to monitor your blood glucose levels and other important numbers to adjust your insulin accordingly.

Without insurance coverage, the Omnipod insulin management system costs $800.00 for the PDM and $30.00 for each pod which can hold enough insulin for up to 72 hours. Even though the price for the PDM is a one-time cost, the pods are not inexpensive and can add up quite quickly.

TIP: For Medicare recipients, having coverage for these costs is a valuable asset.

Advantages of Wireless Insulin Pumps

What are some advantages of using a wireless insulin management system like Omnipod? As insulin-dependent people know, giving yourself multiple injections every day, plus checking your blood glucose levels, and calculating your insulin requirements to fit your daily needs can be stressful and inconvenient.

With a wireless system like Omnipod, Medicare recipients can find the following advantages helpful:

• The pod is small in size so it isn’t uncomfortable and can’t be seen under your clothes
• You can apply the pod practically anywhere on your body
• You can skip your daily injections because you only have to change the insulin-containing pod every 72 hours
• The cannula inserts automatically and very quickly with just the press of a button on the PDM
• It’s easy to program, can be done from a short distance, and through your clothing
• There are no tubes that can tangle or snag
• You don’t have to disconnect or reconnect the tubing
• You have better insulin regulation
• You may have better blood glucose level control
• It may reduce episodes of severe hypoglycemia

Your healthcare provider can help you decide if an insulin management system like Omnipod would work for you.

TIP: Understand the most common reasons why people change their Medicare plan.