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Discussion Starter · #1 ·
Hello fellow diabetics, I’m a new member and new to Medicare. I’m in need of advice on what insulin pump therapy users are doing to get coverage for sensors. Medicare and supplement insurance (that follows Medicare guidelines) are telling me that they cover pump, reservoirs and infusion sets, but not the sensors. Sensors are about $600 for 15 (3 month supply) through Medtronics. Any help is appreciated.
 

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Even though I'm on Medicare, I'm not using a pump so I can't answer your question. There are others here who may be able to answer your question.
There's definitely a learning curve on Medicare.
Welcome to the forum--hope you stick around. There's a lot of good information and helpful people here.
 

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Hi, rham! Welcome to our site!

I don't qualify for Medicare and I don't use a pump, so I don't have a direct answer to your question, either, but, as etherea mentioned, there are posters here who can answer yes to both, so I hope they'll answer your question.

I did a quick Web search about the issue, though, and found a Medtronic Web page you may already have seen in which they provide a phone number "to discuss your options" to Medicare not covering pump sensors. I don't know if they offer an easy payment plan or what, but if you haven't pursued that, it might be worth a call. They do appear to have a program for their CGM users that reduces the price of sensors to $12 each; maybe they just don't want to (or can't) publicize a similar program for their pump sensor users.

I have seen a couple of sites where they claim people have appealed the Medicare ruling based on their doctor prescribing the pump as a durable medical good. And I saw several posts in which people changed the pump they were using to one that was covered explicitly by Medicare.

If others don't pop in here with their experiences, I'd suggest doing a Web search for medicare does not cover insulin pump sensors? and reading the results, noting carefully the dates of the articles because, apparently, this is an environment that is changing relatively quickly (for government agencies).
 

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Hi, rham! Welcome to our site!

I don't qualify for Medicare and I don't use a pump, so I don't have a direct answer to your question, either, but, as etherea mentioned, there are posters here who can answer yes to both, so I hope they'll answer your question.

I did a quick Web search about the issue, though, and found a Medtronic Web page you may already have seen in which they provide a phone number "to discuss your options" to Medicare not covering pump sensors. I don't know if they offer an easy payment plan or what, but if you haven't pursued that, it might be worth a call. They do appear to have a program for their CGM users that reduces the price of sensors to $12 each; maybe they just don't want to (or can't) publicize a similar program for their pump sensor users.

I have seen a couple of sites where they claim people have appealed the Medicare ruling based on their doctor prescribing the pump as a durable medical good. And I saw several posts in which people changed the pump they were using to one that was covered explicitly by Medicare.

If others don't pop in here with their experiences, I'd suggest doing a Web search for medicare does not cover insulin pump sensors? and reading the results, noting carefully the dates of the articles because, apparently, this is an environment that is changing relatively quickly (for government agencies).
Thanks a bunch!
 

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Discussion Starter · #5 ·
Even though I'm on Medicare, I'm not using a pump so I can't answer your question. There are others here who may be able to answer your question.
There's definitely a learning curve on Medicare.
Welcome to the forum--hope you stick around. There's a lot of good information and helpful people here.
Thanks a bunch!
 

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Hi rham69, welcome to the forum.

I'm not an insulin user either but as itissteve suggests, search the WWW if someone doesn't respond soon with answers for your question. My understanding is that Medicare was considering covering CGMs and it was possible that it could be this year. Here is a link to a Fact Sheet they put out about BG monitoring coverage. They do require following of strict rules.

Edit, meant to mention the fact sheet is for providers and CGM starts on the bottom of page 3. Maybe it will be helpful.
 

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Here is another link to medicare.gov on CGMs, may be the best place to start, there is a link to contact them by chat or call on that page.
 

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Hello fellow diabetics, I’m a new member and new to Medicare. I’m in need of advice on what insulin pump therapy users are doing to get coverage for sensors. Medicare and supplement insurance (that follows Medicare guidelines) are telling me that they cover pump, reservoirs and infusion sets, but not the sensors. Sensors are about $600 for 15 (3 month supply) through Medtronics. Any help is appreciated.
Hello rham69,

Welcome to our forum. You will find a wealth of information here. I hope you continue to post.

Have a great day.
 
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