An insulin pump and CGM, plus ongoing supplies, may be fully covered by Medicaid or Medicare if a patient qualifies for either program. And most insurance will cover them at least partially, but there often are high deductibles and co-pays. Still, there may be resources to help.
Because of the differences between Medicaid from state to state, and the difficulty in getting specific coverage questions answered in many states, many diabetics eligible for a pump and/or cgm through Medicaid don't realize it.
Also, in many states, the pumps and cgms are covered by Medicaid, but specific criteria must be met. Some states, like VT, publish the criteria on the internet (http://dvha.vermont.gov/for-providers/continuousglucosemonitoring-011117.pdf).
Although he criteria may appear complicated, most insulin-dependent diabetics can fulfill the requirements. For states that don't publish the criteria publicly, it appears that the requirements may be similar to those of the states that do.
In any case, usually the pump and cgm companies, or their distributors, will handle the insurance, Medicare and Medicaid claims for anyone interested in their products.
So, the first and best step for patients is to fill out the online order/interest form on the pump and cgm companies' websites, then follow up with the companies and they doctors, in order to speed the process along.
Those who can't get an insulin pump and/or CGM covered by Medicaid, Medicare or Insurance, may be able to get assistance from companies, organizations or individuals.
We are in the process of developing a list of some of these resources, and a way to connect potential donors with children and adults who need help getting pumps, CGMs and supplies.
If you fit into any of these groups, please contact us.
Many people find very inexpensive insulin pumps, continuous glucose monitors and supplies on Craigslist and other websites, or from personal connections. The equipment is often, but not always used, but usually in great shape. And the supplies may be extras or leftovers after someone switched devices, upgraded, or even passed away.
Of course, there are risks associated with getting used equipment and secondhand supplies (and from buying anything over the internet). However, for many, this has been an excellent, affordable way to get the equipment and supplies they need, and otherwise couldn't afford.
Over the past few years, a large number of Type 1 diabetics and parents of T1D kids have started using non-commercial, open-source software to integrate insulin pumps, the latest CGMs, and smartphones, creating "closed-loop" systems to automatically adjust insulin every 5 minutes based on CGM readings.
In large part, these systems have been developed, continuously improved, and supported 24/7 online, by diabetics or parents themselves. And, much of the coding and oversight has been done by a small number of dedicated volunteer developers within the larger community.
These "DIY" systems -- Loop, OpenAPS and AndroidAPS -- are in many ways much more advanced, customizable, and convenient than anything commercially available (yet).
And, because the software is free and compatible with older pump models, while the supplies and CGMs may be covered by insurance or Medicaid (or else bought cheaply on Craigslist), the "DIY" systems generally are a very economical way to get the most advanced systems available today.
Because Omnipods are disposable and come in 10-pack boxes for a month, the start-up cost can be much lower than a traditional pump – especially nice if you just want to try them out.. Without insurance (just a prescription), they can be bought directly from a distributor. Or, they can be found on Craigslist (try a national Craigslist search app like cSmart). Plus, when used with DIY Loop and Tidepool Loop (see below), no PDM or Dash controller will be needed.
In 2019, the current style Omnipods should compatible with the DIY Loop iPhone app. Later, they should be compatible with other DIY closed-loop options (like AndroidAPS & OpenAPS). And, within another year or two, the next-generation Omnipods will be compatible with Tidepool Loop, the planned FDA-approved version of DIY Loop.