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does Medicare cover Omnipod Dash

Does Medicare Cover Omnipod Dash?

Diabetes is an illness caused by the rise of blood sugar levels in our bodies. There are two common types of diabetes, Type 1 and Type 2. While there is no cure, there are many treatment options. One of the treatments is through insulin pumps such as Omnipod Dash.

So a common question many people have is, “does Medicare cover Omnipod Dash?” In this article, we answer that question in clear, plain English. You will also find the average costs of Omnipod Dash and other helpful info.

Does Medicare Cover Omnipod Dash?

The short answer is no. In most cases, Medicare will not cover the cost of Omnipod Dash. That said, there may be some situations where you can get these costs covered. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your Omnipod Dash. 

Original Medicare

Original Medicare (Medicare Part A and Part B) does not provide coverage for Omnipod Dash. That is because Original Medicare mainly covers medically necessary services, equipment, and treatment rather than prescription drugs. Prescription drug coverage may be provided by either Medicare Advantage plans or by Medicare Part D.  

Original Medicare provides coverage for many types of treatment for diabetes. This includes a variety of treatments including insulin pumps. However, there are two types of insulin pumps. Those are tubed insulin pumps and tubeless insulin pumps. However, Original Medicare only provides coverage for tubed insulin pumps.

Coverage for tubed insulin pumps is provided by Medicare Part B. Tubed insulin pumps are considered by Medicare Part B as durable medical equipment, or DME, which Medicare Part B covers. 

Medicare Part B covers 80 percent of the costs of your tubed insulin pumps. You will pay for the remaining 20 percent as coinsurance or copayment.

Part C and Part D Coverage for Omnipod Dash

However, some Medicare Advantage plans (Medicare Part C) provide coverage for Omnipod Dash. Medicare Advantage plans cover everything Original Medicare covers and some additional benefits. However, coverage and out-of-pocket costs will vary depending on the specifics of your plan.

Medicare Part C plans that include prescription drug plans will also provide coverage for medications that your healthcare provider will prescribe to you.

Medicare Part D plans also provide coverage for Omnipod Dash. Part D is a prescription drug plan, and just like Medicare Part C, Medicare Part D plans are provided by private insurance companies.

Omnipod Dash is a type of tubeless insulin pump. That is why coverage is provided by Medicare Part D. However, it must be first ordered by your healthcare provider for Medicare Part D to provide coverage. 

Once you have your healthcare provider’s prescription, present it to the pharmacy where you will purchase the Omnipod Dash. 

How Much Does Omnipod Dash Cost?

The average cost of 30 devices of Omnipod Dash insulin pumps is around $2,000. This cost will vary depending on the provider.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series including: Does Medicare cover LINX surgery?

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