Does Medicare Cover Omnipod? 

Insulin is one of the most important hormones your body produces. When you eat foods containing glucose (sugar), insulin allows cells to convert this glucose into energy. If your body doesn’t produce enough insulin or is unable to process insulin correctly, you may experience high levels of blood glucose. This can lead to organ damage, coma and death.

Insulin challenges may lead to diabetes

Seniors who experience trouble producing or processing glucose may be diagnosed with diabetes. This disease often requires insulin injections as well as blood glucose monitoring throughout the day. The standard way to measure blood glucose has been to prick your finger to draw a droplet of blood. This droplet is then placed on a coated test strip to be used in a measuring device.

Although this method of testing is fairly reliable, it is also cumbersome and somewhat painful. Thankfully, seniors who are concerned about blood glucose levels and diabetes can now use solutions like Omnipod to reduce reliance on finger sticks and test strips.

What is Omnipod?

Omnipod is a wearable insulin injection device. It can be worn on the skin where the device also connects wirelessly to other diabetic care devices like the Dexcom G6 continuous glucose monitor (CGM). Combined, these devices measure blood glucose levels throughout the day and send alerts and inject insulin as needed.

Once the Omnipod has been attached to the skin, it can be worn without wires or tubes. Omnipod is not waterproof, but it is water-resistant. Insulin pods are used to refill the device once all of the previous insulin has been injected. 

Does Medicare cover Omnipod?

Seniors who struggle with insulin challenges and diabetes will be happy to know that Medicare benefits are available to help cover the cost of Omnipod. These benefits are available through Medicare’s prescription drug benefit known as Medicare Part D.

This optional insurance coverage helps to pay for prescription drugs that are medically necessary and are prescribed by a Medicare-participating physician. In order to qualify for Medicare coverage through Part D, medications must also be purchasable at a retail pharmacy. Although most covered medical equipment under Medicare receives consideration under Part B, both the Omnipod device and the insulin pods are covered by Medicare Part D.

The exception to this would be when seniors have been prescribed the use of an Omnipod while admitted to a hospital. In such cases, Medicare Part A would supply benefits. Under Medicare Part A, all inpatient care is covered for a period of 60 days in a hospital or 20 days in a skilled nursing facility (SNF) per benefit period.

Does Medicare cover continuous glucose monitors?

In addition to coverage for Omnipod, Medicare recipients can also receive coverage for continuous glucose monitors (CGMs) like the Dexcom G6. These benefits are available through Medicare Part B, the outpatient benefit. Medicare Part B covers durable medical equipment (DME), and CGM devices fall within this category.

Under Medicare Part B, DME is covered at 80%. Not all devices will qualify, and you must be prescribed the use of a CGM device in order for your purchase to qualify for Medicare coverage. In most cases, seniors will need to be diagnosed with diabetes or a disease affecting blood glucose levels in order to obtain coverage from Medicare.

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