Does Medicare Cover Insulin?
- Medicare Part B and Part D can separately cover insulin and diabetes supplies. Find out how much it costs to get a one-month supply of insulin, and learn more about other diabetes supplies Medicare may cover.
Medicare can cover insulin, but exactly how it's covered and the costs you may face can vary depending on the type of Medicare coverage you have. Different parts of Medicare – specifically Medicare Part B medical insurance and Medicare Part D prescription drug plans – can cover insulin and other diabetes supplies in certain situations.
As of January 1, 2023, Medicare Part D plans may not charge more than $35 for a one-month supply of covered insulin, and plans are not allowed to charge a deductible for insulin. This applies to all Part D beneficiaries who take insulin, even those who receive cost assistance from the Part D Extra Help program.
Find out more about your Medicare insulin coverage, the costs you can expect to pay for diabetes supplies and more in this Medicare insulin coverage review.
When Does Medicare Pay for Insulin?
If you are medically required to receive insulin using an insulin infusion pump, then medicare part B will pay for your insulin, but you'll have to look at your plan details.
Medicare does cover insulin and some related supplies, but what's covered depends on your plan.
For example, most Medicare Part B beneficiaries still pay all or most of the costs for:
- Injectable insulin
- Insulin pens
- Alcohol swabs
If you use an external insulin pump that is not disposable, Part B might cover the insulin used with the pump as well as the pump itself. You may have to receive your pump from certain suppliers in order for Medicare to cover it.
You can decrease your out-of-pocket Medicare insulin costs by enrolling in Part B (part of what's called "Original Medicare," along with Medicare Part A) as well as Medicare drug coverage through a standalone Part D plan that works alongside your Original Medicare coverage or a Medicare Advantage (Part C) plan that replaces your Part A and Part B coverage and includes Part D drug coverage.
Does Medicare Part B Cover Insulin?
Medicare Part B covers insulin when it is medically necessary with the use of an insulin pump, since it is recognized as durable medical equipment in this case. That insulin is covered 80%, and you will need to pay 20% of the Medicare-approved cost unless you have a Medicare supplement plan to pick up the difference.
Does Medicare Part D Cover Insulin?
The bulk of insulin coverage comes from Medicare Part D (Prescription Drug Plans, or PDPs) and Medicare Advantage plans that include prescription drug coverage (Medicare Advantage Prescription Drug Plans, or MA-PDs).
As mentioned above, Medicare Part D plans can't charge more than $35 for a one-month supply of covered insulin. Beginning July 1, 2023, similar spending limits will be applied to any insulin covered by Medicare Part B.
Part D plans may also help you pay for some medical supplies used to inject insulin, like alcohol swabs, gauze and syringes.
The Inflation Reduction Act
The $35 spending cap on insulin was made possible by the Inflation Reduction Act, which was signed into law in August of 2022. In addition to capping one-month costs of insulin at $35, the law also:
- Allows Medicare to negotiate drug prices with manufacturers
- Requires drug companies to pay rebates to Medicare if the cost of drugs used by Medicare beneficiaries rises faster than inflation
- Caps annual out-of-pocket spending at $2,000 for Medicare Part D beneficiaries beginning in 2025
- Eliminates cost sharing for adult vaccines covered by Medicare Part D and improve access to vaccines covered by Medicaid and CHIP
- Expands eligibility for full benefits under the Medicare Part D Low-Income Subsidy Program
How do I Sign Up For Medicare Insulin Coverage?
You may enroll in a Medicare Part D or Medicare Advantage plan with prescription drug benefits during the fall Medicare open enrollment period that takes place from October to December 7 each year. You may also enroll during your Initial Enrollment Period, which begins three months before you turn 65 years old and ends three months after your birthday. Depending on your personal situation, such as having employer- or union-provided health insurance past the age of 65, you may be able to enroll in Medicare drug coverage at a different time of year outside of your Medicare initial enrollment period and the fall open enrollment period.
Contact a licensed insurance agent for help reviewing plans available in your area and to compare the benefits and costs of each to find the best plan for your needs.