Does Medicare Cover Insulin?
- Does Medicare cover insulin via Medicare Part B or D? Find out how much it costs to get a one-month supply on these Medicare plans.
Medicare is a federal health insurance program for those over the age of 65 and some people who have disabilities. If you live with diabetes, you may be asking, “Does Medicare cover insulin?” The answer is that it depends on the kind of insulin you use and the Medicare plan you have.
When Does Medicare Cover Insulin?
Medicare does cover insulin and some related supplies, but what's covered depends on your plan.
For example, most people using Medicare Part B still pay all or most of the costs for:
- Injectable insulin
- Insulin pens
- Alcohol swabs
People who have Medicare Part D pay for:
- Insulin pump supplies
The best way to decrease your total out-of-pocket cost for insulin under Medicare is to have both Part B and Part D.
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?
You may be able to get Medicare drug coverage that provides access to non-pump insulin at a lower cost of $35 for a 30-day supply. This is a benefit under Part D plans as of January 1, 2021.
To get the $35 insulin cost savings you need to:
- Join a Medicare drug plan (Part D plan)
- Join a Medicare Advantage Plan that also comes with drug coverage
The plan you choose needs to be part of the insulin savings model.
Part D plans may also help you pay for some medical supplies used to inject insulin, like alcohol swabs, gauze and syringes.
How Much Do You Pay for Insulin With Extra or Partial Extra Help?
If you receive partial Extra Help, then you could pay up to $92 and 15% coinsurance for each month of insulin you receive through your pharmacy. The amount you pay could be more or less than the insulin savings model’s $35 fee.
With full Extra Help, the copayment for insulin is less than $35 per month thanks to the Senior Savings Model.
Cal 1-800-MEDICARE if you want to know if you qualify for or receive Extra Help.