Qualifying for an Insulin Pump with Medicare

If you’re thinking about an insulin pump, start by talking to your doctor to see if you’re a candidate. Healthy Living can walk you through the next steps, including what you’ll need to qualify per Medicare guidelines. People with Type 1 & Type 2 diabetes both can get pumps if they qualify using this criteria:

Obtaining qualifying lab results – C-Peptide & fasting glucose, tested on the same day at the same time
Currently testing blood glucose 4 times/day
Using Multiple Daily Injections
Having gone through a comprehensive diabetes education program

Note: If your labs don’t qualify initially, we suggest that you discuss your options with your doctor.

How Medicare Bills for Pumps

Insulin pumps bill as a rental through Medicare for 13 months. The pump is considered your property after 13 months have passed. Medicare will cover 80% of the insulin pump for qualifying members. If you have secondary insurance, we will verify that insurance to find out if they will cover the remaining 20% of the cost.

The Process for Starting on an Insulin Pump with Medicare & Healthy Living

The Healthy Living Insulin Pump & CGM Therapy Team will work closely with you to guide you through completing your qualifying criteria as well as verifying your insurance to give you estimated out-of-pocket costs for the pump.

Once these pieces are in place and you are ready to order an insulin pump, we will ask you to fill out two Medicare forms: The Assignment of Benefits form and the Rental Agreement. These forms give us permission to bill Medicare on your behalf.

Contact our Insulin Pump & CGM Therapy Team to find out which pumps are available. Once you are on an insulin pump, if your insurance changes or you discontinue using the pump for any reason, please notify us.

For Medicare Insulin Pump Owners

The 13-month rental period is now over and you now own your insulin pump. Your pump has a 4-year warranty offered by the manufacturer. Under Medicare guidelines, patients are eligible for a new pump every 5 years, but exceptions can be made if the 4-year warranty has expired and your pump is malfunctioning.

Contact the Healthy Living Insulin Pump & CGM Therapy Team to find out when you are eligible for a new pump, for help getting started with an insulin pump, or to learn more about pumps or CGM. You can reach them at (866)779-8512 (Option 2).