Staying Fit
In this story
Insulin options • Part D coverage • Caveats • Part B • Keep in mind
Yes, Medicare covers insulin, but coverage depends on how you administer your insulin.
Medicare coverage has improved significantly in the past few years, which is good news for the more than 3.3 million Medicare beneficiaries who have diabetes and use insulin to help regulate their blood sugar.
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Your options:
- If you have a Medicare Part D prescription plan or a Medicare Advantage plan with drug coverage, you should be covered for injectable insulin.
- If you use an insulin pump that’s not disposable, Medicare Part B can cover the pump and insulin.
- Medicare parts B and D also cover tests, services and supplies specifically for people with diabetes.
When does Medicare Part D cover insulin?
Part D prescription drug plans cover insulin that you inject yourself or use with a disposable insulin pump.
Thanks to the Inflation Reduction Act, all Part D and Medicare Advantage plans now must cap users’ out-of-pocket costs for a 30-day supply of insulin at $35. This cap, which took effect in 2023, means the plans can’t charge you a deductible or higher copayments for insulin covered by the plan.
In 2026 and beyond, the monthly insulin copay will be $35 or 25 percent of the medication’s negotiated price, whichever is lower.
How do I find out if a Part D plan covers my insulin?
The $35 cap applies only to insulin products on a plan’s list of covered medications, called a formulary. Before choosing a plan, make sure it covers the insulin you use and compare coverage for your other medications, too.
You can use the Medicare Plan Finder to compare how each Part D and Medicare Advantage plan in your area covers your specific medications, including insulin.
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