Quick facts about insulin and diabetes
1 in 4 adults over 65 in America have diabetes.1 Diabetes occurs when your body doesn’t make enough insulin, can’t use insulin well or both.
Insulin is a hormone made in your pancreas. It allows your body to use glucose for energy and helps balance your blood glucose levels. If you have diabetes—type 1, type 2 or gestational—insulin therapy can be an effective way to replace or supplement your body’s natural insulin.
Let’s explore the ways Medicare covers insulin.
When does Medicare Part B cover insulin?
Original Medicare Part B will only help pay for insulin if the use of an insulin pump is medically necessary. If you use an insulin pump, you pay 20% of the Medicare-approved amount after you meet the Part B deductible ($164.90 in 2023).2
Some diabetic services and supplies that Part B may help cover include:3
- Diabetes screening tests
- Diabetes self-management training
- Home blood sugar (glucose) monitors
- Supplies, including blood sugar test strips, lancet devices and lancets
In general, Part B helps cover the services and supplies that affect people with diabetes—not the insulin itself. You pay 100% for insulin unless it’s used with an insulin pump.
When does Medicare Part D cover insulin?
Medicare Part D prescription drug plans may cover injectable insulin not used with an insulin infusion pump and inhaled insulin.4 Part D plans that participate in the Part D Senior Savings Model, which Humana calls the Insulin Savings Program, may also offer coverage choices that include multiple types of insulin (rapid, short, intermediate, etc.) at a maximum copayment of $35 for a 30-day supply.5
Some diabetic supplies that Medicare Part D may help cover include:6
- Syringes
- Insulin pens with or without included insulin
- Needles
- Inhaled insulin devices with or without included insulin
How to afford insulin on Medicare
If you have Original Medicare and need help covering the cost of insulin, help is on the way starting January 2023. The cost of insulin will be capped at $35 for a 30-day supply for all seniors on Medicare. You will no longer need a Part D plan to benefit from this $35 out-of-pocket cost limit.7
There are also some other ways you can save money on insulin. These include:
- Comparing pharmacies for the least expensive insulin prices
- Asking your doctor if there is a generic or less expensive insulin you can take
- Calling your health insurance company to find out which insulin is covered at the lowest cost to you
- Looking for insulin savings programs or coupons that can help cut the cost
If you get full Extra Help, your copayment for insulin is lower than the $35 copayment for a month’s supply under the Senior Savings Model.
How to enroll in a Medicare Part D prescription drug plan
There are 2 ways you can get prescription drug coverage. You can enroll in a stand-alone Medicare Part D plan, or you could get drug coverage as part of a Medicare Advantage plan.
Here are a few different ways you can enroll:
- Use Medicare’s plan finder tool to enroll online
- Call the plan you want to enroll in
- Call 1-800-Medicare, available 24 hours a day, 7 days week (except some federal holidays)
For more information, including when you can sign up for a Medicare Part D plan, see this article on enrolling in a Medicare Part D prescription drug plan.
