Medicare and Insulin Pumps: What You Need Know

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Medicare recipients who have diabetes are entitled to coverage for certain diabetes supplies. To qualify, you must be enrolled in Medicare Part B. Recipients who enroll in a Medicare Advantage Plan may be subject to different rules than those with Original Medicare. However, at the minimum, Medicare Advantage Plans must provide the same coverage as an Original Medicare plan.

Medicare Coverage for Diabetes

To have Medicare coverage for diabetes supplies, you must have Part D. Medical supplies for administering insulin are covered. Supplies may include:

  • Alcohol swabs
  • Gauze
  • Lancet devices
  • Lancets
  • Syringes
  • Insulin pump devices not covered under Part B

There may be a limit on how often or how much of the cost of these devices Medicare will cover. The durable medical equipment benefit may qualify for devices that Part B doesn’t cover.

How the Inflation Reduction Act affects insulin prices

The Inflation Reduction Act was passed to make insulin and prescription drugs more affordable for Medicare recipients who already have Medicare Part D. The price of insulin caps will be $35 per month starting in 2023, including insulin pump usage. The new legislation ensures that all seniors who use insulin prescribed by a doctor will benefit from the lower cost.

The Inflation Reduction Act makes further changes beginning in 2026, so seniors may pay less than $35 per month for insulin. Medicare will provide reimbursement to ensure seniors can take advantage of the lower insulin price if they’re charged more than $35 per month. A deductible doesn’t apply to insulin. The new legislation regarding insulin costs applies to everyone on Part D, even if you qualify for an Extra Help program. Extra Help is for people with limited resources and income to pay for:

  • Co-insurance
  • Deductibles
  • Medicare Part D premiums

What is insulin pump therapy for diabetes?

An insulin pump is a device that helps people to manage their diabetes effectively. The pump gets consistent and custom doses of insulin into the body 24 hours each day to accommodate your needs. Background insulin pumps a small amount of insulin to the body all day. Mealtime insulin is an additional dose that can accommodate high blood sugar or food intake.

Insulin continuously pumps into the body through an infusion tube. Many people with diabetes experience improvements in their diabetes, including:

  • Accurate insulin doses
  • Convenience
  • Customized therapy
  • Fewer insulin injections
  • Lower A1C
  • Mealtime dosage

You should discuss your diabetes with your primary care physician to see if you’re a good candidate for an insulin pump. Your doctor may prescribe an insulin pump under these conditions:

  1. You take oral medications besides insulin to manage your diabetes
  2. You take three or more injections of insulin per day
  3. You want to manage your diabetes more effectively
  4. Any insulin pump and all the components require a prescription. Insulin infusion pumps and all the parts are available for sale on a doctor’s order.

Insulin for Pumps

The Inflation Reduction Act also applies to insulin for an insulin pump. As of July 1st, 2023, the cost of insulin for any durable medical equipment or DME must not exceed $35 per month. The Part B deductible doesn’t apply to any DME. Recipients that have Medicare Supplement Insurance or Medigap that currently pays for Part B should be eligible for the $35 per month cost. Anyone on Medicare should check their Part B co-insurance to see if the cost is covered.

If you use an insulin pump that’s external and not disposable, your Part B may cover the cost of insulin and the insulin pump as durable medical equipment. However, Medicare rules are different depending on the area of the country in which you live. In some regions of the country, you must use specific insulin pump suppliers for Medicare coverage.

People who are good candidates for insulin pumps

People with diabetes who tire of giving themselves frequent injections are good candidates for an insulin pump. The pump is a computerized device that’s small and is worn discreetly. The catheter is inserted into the skin’s fatty tissue and taped in place. Some people choose a pump over injections for convenience. A pump is a good option for anyone who wants to lower their A1C level. Diabetes can be managed with a pump or insulin injections, depending on preference.

An insulin pump is an excellent choice for anyone who likes the concept of the pump’s calculator functions to determine the exact dose of insulin. The pump is preferable for many people who suffer from gastroparesis. The condition is also known as gastric emptying, which stops or slows food movement from the stomach to the small intestine when there’s no blockage.

Additional insulin pump factors to consider

People with diabetes must learn the technical issues associated with an insulin pump. You should still check your blood sugar level regularly. If the catheter accidentally comes out, you may have to inject insulin until the catheter can be reinserted.

It’s essential to check the prices of insulin pumps before committing. Some insulin pumps are more expensive. You should check with your Medicare plan to determine if the insulin pump cost is covered under your plan. The pump is a small device but may take getting used to.

The bottom line is that people have choices when it comes to using an insulin pump. Some people may have minor skin irritation at the infusion site and prefer injections until the area heals. Discussing insulin pumps with your doctor and finding out what your Medicare plan covers is best before making a choice.

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