Medicare Covered Insulin and Costs

Medicare covers insulin for eligible beneficiaries, but the out-of-pocket costs may vary depending on the specific Medicare plan and the type of insulin prescribed. In 2021, beneficiaries who are enrolled in a Medicare Part D plan may pay up to 25% of the cost of insulin, with a maximum monthly cost of $35 for a 30-day supply. However, some Medicare Advantage plans may offer lower out-of-pocket costs for insulin.

Starting in 2023, Medicare Part D beneficiaries will have a $35 monthly cap on insulin copays, regardless of the type of insulin they use, thanks to a provision in the Bipartisan-Bicameral Omnibus COVID-19 Relief Deal passed in December 2020.

It's important for beneficiaries to check with their specific Medicare plan to understand their individual costs for insulin. They can also contact Medicare directly or visit the Medicare website for more information.

• What if I get a 60- or 90 day supply of insulin?
  Your costs can’t be more than $35 for each month’s supply of each covered insulin. For example, if you get a 60-day supply of a Part D-covered insulin, you’ll generally pay no more than $70.
• Note: Starting July 1, 2023 similar caps on costs for insulin will apply for such used in traditional insulin pumps (covered by Medicare Part B).

When Medicare covered insulin will be capped

Beginning in 2023, the cost of a one-month supply of each Part D-covered insulin will be capped at $35, and you will not be required to pay a plan deductible for insulin. This applies to everyone who takes insulin, even if you get Extra Help (LIS).

For insulin used with a traditional insulin pump that is covered under the Medicare durable medical equipment benefit, you pay 20% of the Medicare-Approved Amount after you meet the Part B deductible if your plan has one. You pay 100% for insulin-related supplies (such as syringes, needles, alcohol swabs, and gauze), unless you are enrolled in a Part D plan.

Things to know

Part D covers these:

• Injectable insulin that isn't used with a traditional insulin pump
• Insulin used with a disposable insulin pump
• Certain medical supplies used to inject insulin, like syringes, gauze, and alcohol swabs

If you use an external insulin pump that isn’t disposable, Part B may cover insulin used with the pump and cover the pump itself as durable medical equipment (DME). If you live in certain areas of the United States, you may have to use specific insulin pump suppliers for Medicare to pay for a durable insulin pump.

Medicare Part B (Medical health Insurance) does not cover these:

• Insulin unless use of an insulin pump is medically necessary
• Insulin pens
• Syringes
• Needles
• Alcohol swabs
• Gauze