@John_S2 - Some others can likely answer the Medicare questions better. @Laddie is really good with that information.
But I will take a crack at it anyway - but still using info from Laddie.
My understanding with some of this is if a distributor (or if using the manufacturer as the distributor) has a contract with Medicare than they are legally not allowed to charge a Medicare recipient outside the allowed reimbursement. Dexcom ran into this with some of its G5 patients earlier this year. Here is a quote from a VP of Dexcom from May 2, 2017:
“In addition, because of the January CMS ruling, we’re prohibited by law from balance billing our existing cash-pay Medicare eligible patients, which we estimate accounted for approximately $2 million to $3 million in lost sales during the quarter.”
So if you wanted to do something outside of Medicare and pay for it yourself (which would by all accounts appear to be perfectly legit for you even if it was an issue for a company with a Medicare contract), I would think you would have to do it through a distributor with which you have never done business such that they have no idea you have Medicare. Or a distributor who simply has no contract with Medicare although I doubt such exists.
On the bright side, if you have 2 years into your pump now and if Medicare allows a new pump after 5 years and if the Tandem upgrades are delayed (seems like most things get at least minor delays) such that it is maybe 2 years before the Tandem software updates are actually released than potentially you might only end up having to wait one year or so from when all the Tandem updates are available and when you can upgrade to the newest Tandem pump that would take advantage of these.
Laddie does discuss this topic on her blog:
“Unfortunately I will be on Medicare by the time the 670G is released and Medicare beneficiaries are not allowed to participate in manufacturer upgrade programs. I have been told that this rule is part of anti-fraud regulations, but it truly makes no sense to me. It is not as though there is any cost to Medicare to allow me to upgrade if I pay the out-of-pocket cost (if any) and I don’t see how anything about it is fraudulent.”