Navigating Medicare for People with Type 1 Diabetes

By G. W.

Understanding Medicare can be overwhelming, especially when managing the unique healthcare needs of living with Type 1 Diabetes (T1D). From insulin coverage to durable medical equipment like continuous glucose monitors (CGMs) and insulin pumps, knowing what’s available and how to maximize your benefits is essential for your health and peace of mind.

Fortunately, there are resources to help you make sense of your options. Whether you’re new to Medicare or reviewing your plan during open enrollment, taking time to understand your coverage choices can make a big difference in your care. Here’s some practical wisdom to help you get started or refine your plan.

Medicare Reference Sites:

Medicare.gov

• (Then use the Health and Drug Plans dropdown). This is one of the most important places to look for information.
• Omnipod is not shown in the drug tables, so you have to go to the specific Part D or Advantage plan to see if Omnipod is covered. It makes it difficult to shop, for sure.
• Also, note that plan shopping does not require a login. Most diabetics will need to go to the individual plans on the carrier website. (Note: brokers pretty much have to call the carriers also).

Chronic Condition Special Needs Plans (C-SNPs) 

• C-SNP plans have much better diabetes coverage (in general). They do sometimes require verification of diagnosis, but your carrier can do the verification with your doctor’s practice on the first day the plan was active. These are mostly Advantage plans.

DiabetesMine

• From what we could see, the good options for Part D plans that cover diabetes well are limited and priced higher but are probably the better option for those who have means. If you get a Part D, you need a G/N Medigap also, but these are fairly same/same.
• I am on an Advantage plan specifically tailored to people with chronic health issues and in my 23 days on the plan and Medicare, I think it’s fabulous. But I have the option to get out of the plan and go to Medigap option as long as I leave it by October 1, 2025 (1 year after my 65th birthday) without underwriting consideration.

Medicare and Diabetes: A Comprehensive Guide for Seniors and Their Caregivers

• Developed by Integrated Diabetes Services, this article covers all the basics and is very easy to understand for both T1Ds and caregivers.

TCOYD

• This article is very general, but quick and to the point. The only thing they didn’t cover is that a drug plan that includes Omnipod can be expensive (more than the average $55 cost of a drug plan). The article was very general and quite factual and we consider it better than the DiabetesMine article. It was probably the best general article on the list.

Other Sites

• Heal Medicare: Not diabetes-specific. The general knowledge was very top level and not specific and was more of a push for their counseling service.
• CMS HHS-YouTube: Medicare & You: Deciding to Sign Up for Medicare Part B: Very general and oriented to screening (so ultimately Type II). Not as applicable to most of us.
• ADA: Very general and basic. This one was not very concise. I actually like the TCOYD one better at first glance.
• Breakthrough T1D: Tries to cover all elements for open enrollment in one short article. Doesn’t provide everything you may need.
• Beyond Type 1: Good initial enrollment article. There are so many state-by-state issues, the articles have to stay pretty generic. Some of the info may be outdated, so double check with other sites.