@HighHopes I created a new topic for your question. The answer is in the Medicare Infusion Pump LCD (Local Coverage Determination). As of May 2025 it says:
Continued coverage of an external insulin pump and supplies requires that the beneficiary be seen and evaluated by the treating practitioner at least every 3 months.
I suggest bookmarking this page and checking it once a year for updates as long as you have Part B and a pump covered by it. The document gets updated often and personally I had to read it more than few times to really understand it.
I may need to look into this as I read the same thing, 1 visit per 3 mos/90 days/once per quarter. However, based on my blood tests and numbers, my Endo changed to 1 visit every 6 months about a year back. Yet my pump, CGM, and insulin still get covered by Medicare and TFL. I presume either Medicare isn’t enforcing their own reg (possible) or TFL is picking up the slack (possible but not likely), or I’m somehow “slipping” thru the system (doubtful) given today’s push for cost savings. At some point, I’m sure someone will cry out and I’ll get a surprise bill, at which point the fight will begin in earnest. Seems they can either pay the Endo and blood test costs or pay for the supplies…not sure which is less, we’ll see…
Yep, still Dash pods. I like tubeless and it works with Trio and Loop, the DIY AIDs I’ve used for 3+ years. I’m using it w/Trio (I was a closed beta tester and am continuing as a public beta tester). I still have a Dash PDM I take on long trips as a backup but haven’t had to use it. I use it with a G7 (switched from G6 about a year ago), works as well or better for me. Insulet changed the BT board incorporated on the Dash pods recently; it’s causing some compatibility issues w/iPhone 16’s. Questions?
The every 3 months requirement only applies to pumps covered by Medicare Part B. At this time Part B does not cover Dash (and Omnipod 5) pumps so it doesn’t apply to you. They are covered by some Part D plans, those plans can have their own requirements. I haven’t yet heard from anyone with a pod tripping over a doctor visit requirement. You mentioned also having Tricare, I don’t know how that affects anything.
Thank you for mentioning the Dash hardware change, I’ll have to keep an eye on how that works out in case my endo changes her mind about prescribing them for me. Hope it isn’t causing you problems.
@spdif Thanks for the info on the Part B coverage and Dash not being covered; means TFL (as my secondary) is picking it up as payor. I think I had looked that up at one time, but it’s been awhile; I dislike working with Medicare and TFL EOBs, they seem confusing with charges getting strung out for months/years making it nearly impossible to figure who’s paying for what and when. I fill “long term” scripts at a military pharmacy and have never been clear of who is paying for them.