An example of such an insulin pump covered by Medicare Part D plans is Insulet Corporation's Omnipod® System.
(For more information, please see diatribe.org/insulets-omnipod-now-eligible-medicare-coverage).
Non-disposable Insulin Pumps and Medicare Part B coverage.
Traditionally, Medicare Part B covered insulin pumps as durable medical equipment (DME) and the CMS document, "Medicare Coverage of Diabetes Supplies & Equipment" notes:
"If you use an insulin pump worn outside the body (external) that isn't disposable, Part B may cover insulin used with the pump and the pump itself as durable medical equipment. If you live in certain areas of the country, you may have to use specific insulin pump suppliers for Medicare to pay for a durable insulin pump."https://www.medicare.gov/publications/11022-medicare-coverage-of-diabetes- supplies-services-and-prevention-programs.pdf (June 2025)
In regards to insulin, the CMS document also adds,
"Part B covers insulin if you use an insulin pump that's covered under Part B's durable medical equipment benefit. Part B covers durable insulin pumps worn outside the body (external), including the insulin used with the pump.
If you have a Part D plan, it may cover:
The cost of a one-month supply of each Part B- and D-covered insulin is no more than $35, and you don't have to pay a deductible for your insulin. This applies to everyone who takes insulin, even if you get Extra Help (a Medicare program to help people with limited income and resources pay Medicare Part D premiums, deductibles, coinsurance, and other costs).
- Injectable insulin that isn't used with a traditional insulin pump
- Insulin used with a disposable insulin pump
- Insulin that's inhaled
If you get a two-month or three-month supply of insulin, your costs can't be more than $35 for each month's supply of each covered insulin product. For example, you'll generally pay no more than $70 for a two-month supply of covered insulin. Similar limits on costs apply for insulin used in traditional insulin pumps covered under Part B." [emphasis added]
Disposable Insulin Pumps and Medicare Part D coverage.
CMS notes:
"Part D covers certain medical supplies used for insulin injections (like syringes, needles, alcohol swabs, gauze). Some Medicare Part D plans may also cover disposable pump devices that deliver insulin." [emphasis added]The 2018 CMS guidance continues on to note:
"newer insulin delivery devices in the form of both mechanical and electronic insulin pumps have become available that are not coverable under the Medicare Part B durable medical equipment (DME) benefit. Consistent with the Part D policy to allow coverage of insulin delivery devices that are 1) directly associated with delivering insulin into the body and 2) not otherwise considered DME under Part B, Part D sponsors may provide coverage of such products under Part D as 'medical supplies associated with the injection of insulin.'"Question: How do I find a Medicare Part D plan that covers such a disposable insulin pump?
Unfortunately, with a little bit of work. Although insulin pumps like the Omnipod® can be prescribed by your doctor, the Medicare Plan Finder (as of 06/06/2025) does not include this insulin pump in their drug data - and so you cannot add this device to your drug list when searching for a Medicare Part D or Medicare Advantage plan.
As a note, our Medicare Part D Drug Finder ( on this site) will search for drug coverage across all Medicare Part D plans in an area alphabetically or by National Drug Code (NDC) - an 11-digit system to uniquely identify a drug. However, at this time, although you can get a prescription for insulin pumps such as the Omnipod, there is no data or NDC for this “delivery system” included within our formulary data. And although, like syringes used for the delivery of insulin, non-DME insulin pumps may be covered by your Medicare Part D plan, you will need to look closely in the plan's printed information or contact your plan's Member Services department to learn more about coverage and cost.
Therefore, it is a little difficult (without contacting every Medicare Part D drug plan in your area) to systematically search for a Medicare Part D plan that covers this device (see the information below for a list of Medicare Part D plans and Medicare Advantage plan covering the Omnipod. On a positive note, the Omnipod® website provides some additional direction for finding the Part D drug plans (PDP and MAPD) that cover Omnipod and working with a Medicare Part D plan that has not yet added this device to their list of covered drugs.
"Unlike pharmaceutical products, Omnipod will not appear on Medicare's plan finder site since it is a medical device.
Have Medicare do the legwork for you
- Call 1-800-MEDICARE (1-800-633-4227) and speak with a representative [-or]
- Search the Medicare.gov plan finder site, using the following instructions:
- Make a list of your current medications other than Omnipod.
- You can create an account or just enter your zip code and select the plan type (e.g. Medicare Advantage).
- Follow the prompts to add all medications. Once all prescriptions are added other than Omnipod, click “done adding drugs”.
- Add pharmacy and click “done” - a list of plans will populate.
- Find a plan that looks most suitable, click “plan details” to get contact information for further questions regarding Omnipod coverage."
In short, you can choose the most affordable Medicare Part D drug plan that covers all of your medications and then see if your plan is covering the disposable insulin pump.
If the Medicare plan does not cover the disposable insulin pump, but you wish to join the plan because of the other coverage benefits, then you can work with your Medicare plan through the “formulary exception” process to get a non-formulary item covered. Asking your drug plan formulary exception means that you are asking your plan to cover a non-formulary drug usually at a fixed higher-tier price. But, asking for a formulary exception is not always met with immediate success and coverage of the non-formulary drug. Your plan may reject your request and you may need to appeal any negative decision through several levels.
You can read more about formulary exceptions and the appeals process
on this site
Examples of Medicare drug plans covering a disposable insulin pump?
At the current time, the Omnipod® System is covered on the following
Part D plans under a Tier 2, Tier 3, or Tier 4 copay benefit. These may be the
most cost-effective options for your Omnipod prescription (including coverage of the Omnipod® 5 Automated Insulin Delivery System and the Omnipod DASH® Insulin Management System).
Medicare Part D and Medicare Advantage plans covering an Omnipod product
(Reference: https://www.omnipod.com/is-omnipod-right-for-me/coverage/medicare 06/06/2025)
- AARP Medicare Advantage plans
- AARP MedicareRx Preferred (PDP)
- AARP Secure HorizonsMedicare Advantage plans
- Blue Cross MedicareRx Value (PDP)
- Cigna Extra Rx, Saver Rx Secure Rx (PDP)
- Cigna Preferred Savings Medicare Advantage plans
- Cigna True Choice Medicare Advantage plans
- Clear Spring Health Value Rx (PDP)
- Express Scripts EGWP High Performance 3 Tier (PDP)
- Express Scripts EGWP Premier Access 3 Tier (PDP)
- Express Scripts EGWP Premier Performance 4 Tier (PDP)
- Humana Advantage plans (Preferred, Tier 3)
- Gold Plus & Gold Plus SNP
- Choice & Choice SNP
- Medicare Employer MA-PD