Medicare Part B and Insulin Coverage

[steveadlman]

If a person has an external insulin pump will Medicare Part B automatically cover the insulin? Are there specific medical conditions a person has to meet before insulin is covered under Part B when a person uses an external insulin pump? I have had clients asked their doctor and the doctors seem to be clueless.

 

[goillini52]

If a person has an external insulin pump will Medicare Part B automatically cover the insulin? Are there specific medical conditions a person has to meet before insulin is covered under Part B when a person uses an external insulin pump? I have had clients asked their doctor and the doctors seem to be clueless.

https://www.medicare.gov/coverage/insulin.html

 

[kgmom219]

https://www.medicare.gov/coverage/insulin.html

PLUS..the doctors don't know.

You are getting into the mud on this one. It depends on the pump. Is internal or external pump? Where do they get the pump? Where do they get the insulin? Is it cartridges covered under D? Is it vials that they put in there?

Start with the supplier (and if its the docs office, ask the claims girl. NOT the doc). If its a pharmacy, call them. If you can get it from liberty medical, call them.

My generic answer would be: are you able to put the insulin in the pump without a doctor? If so, let's see if the cartridges/vials are covered under Part D. The actual pump would probably be covered under Part B, as DME.

 

[G.Gordon]

There is a difference in type 1 and type 2 diabetics. It is not covered for one of them, can't remember right now.

 

[somarco]

Good luck finding a pharmacy that files the insulin under Part B. That's been my biggest challenge so far.

 

[GCRN]

I work in a Diabetes Clinic, we have a multitude of Medicare patients on insulin pumps. Rule of thumb ... if you qualify for the pump through Medicare, you should qualify for Part B coverage of insulin for use in the pump. We often recommend going through Walgreen's. Walgreen's home office processes & submits the claims to Medicare Part B, the authorization usually takes a day or two. It helps to have a written Rx with diagnosis code, pump make/model/serial number and date of purchase. If you are being told that they don't file claims to medical benefits, my advise would be "be persistent", ask to speak to the pharmacist, if necessary.
With that said, I must add that we do not have the same success in getting those with Humana policies the same benefits.

It's not easy, and that is unfortunate, it should be! Good Luck to all!

 

[LewB]

Good luck finding a pharmacy that files the insulin under Part B. That's been my biggest challenge so far.

I have a client that told me that his local Walmart Pharmacy is willing to provide and file his insulin for his pump under Part B

 

[kstein]

Anyone have any follow up thoughts to this thread? I have a client in MO getting the runaround. Does the competitive bidding process and "regions" change what is available to people at all?

 

[dandan]

Yes Medicare will cover insulin under part B, if you are on an insulin pump.

 

[kstein]

That didn't really help....