Although Original Medicare Part A (Hospital Insurance) doesn’t pay for insulin, Part B (Medical Insurance) and Part D (Drug coverage) may offer some coverage for insulin and diabetic supplies.

Key points1

  • The Inflation Reduction Act has capped the cost of insulin at $35 per month (up to 30 days) for people who have Medicare—including those who use insulin pumps.
  • All Medicare bee who use insulin can benefit from this out-of-pocket cost limit.

1 in 4 adults over 65 in America have diabetes.2 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. Your cost for a month’s supply of Part B-covered insulin for your durable medical equipment (DME) pump can’t be more than $35, and the Part B deductible won’t apply.3

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, which includes Medicare Advantage Prescription Drug plans (MAPD) and standalone prescription drug plans (PDP), may cover inhaled insulin and injectable insulin not used with an insulin infusion pump. The cost of a 1-month supply (up to 30 days) of each Part D-covered insulin is capped at $35, and you don’t have to pay a deductible for insulin. This applies to everyone who takes insulin. If you get a 60- or 90-day supply of insulin, your costs can’t be more than $35 for a month’s supply of each covered insulin.3

Some diabetic supplies that Medicare Part D may help cover include:3

  • Syringes
  • Needles
  • Gauze
  • Alcohol swabs
  • Insulin pump devices

How to afford insulin on Medicare

The Inflation Reduction Act has helped make insulin more affordable for Medicare beneficiaries. If you’re looking for ways to save more money, try 1 of these cost-saving tips:

  • Compare pharmacies for the least expensive insulin prices
  • Ask your doctor if there is a generic or less expensive insulin you can take
  • Call your health insurance company to find out which insulin is covered at the lowest cost to you
  • Use manufacturer rebates and coupons.

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.

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Sources

  1. “What you Need to Know: Important Information about the Inflation Reduction Act and Diabetes,” American Diabetes Association, last accessed July 5, 2023, https://diabetes.org/sites/default/files/2022-08/What-People-with-Diabetes-Need-to-Know-about-the-Inflation-Reduction-Act.pdf, PDF.
  2. “Prevalence of Both Diagnosed and Undiagnosed Diabetes,” Centers for Disease Control and Prevention, last accessed July 5, 2023, https://www.cdc.gov/diabetes/data/statistics-report/diagnosed-undiagnosed-diabetes.html.
  3. “Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs,” U.S. Department of Health and Human Services,” last accessed July 5, 2023, https://www.medicare.gov/Pubs/pdf/11022-LE-Medicare-Coverage-of-Diabetes.pdf, PDF.