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Does Medicare cover insulin?


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 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.

Part D also covers supplies, so you’ll foot less of the bill for items used to administer insulin, such as alcohol swabs, gauze, inhaled insulin devices, needles and syringes.

When does Medicare Part B cover insulin?

Special rules apply for external pumps. If you take insulin through a pump that’s not disposable, often a battery-operated smartphone-size computer that delivers the hormone at scheduled times throughout the day, the pump and insulin can be covered through Medicare Part B as durable medical equipment.

The cost of insulin used in the insulin pumps that Part B covers is capped at $35 a month and is not subject to the Part B deductible.

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Part B also covers diabetes supplies separate from what Part D covers, including blood sugar testing monitors, glucose test strips, glucose solutions and lancets you use to draw your blood. After you’ve met the Part B deductible, which is $240 in 2024, you’ll pay 20 percent of the Medicare-approved costs.

Keep in mind

If you have trouble affording Medicare Part D coverage, you may qualify for the Extra Help program, which can help pay Part D premiums, deductibles and copayments. Extra Help eligibility is based on income. Here, too, thanks to the Inflation Reduction Act, income levels have been expanded to allow more people to qualify. In 2024, your monthly income must be below $1,883 if you’re single or $2,555 if you’re married.

Video: This New Medicare Benefit Lowers Insulin Costs

While you’re in the Extra Help program, you can change your Part D plan as often as once every quarter. Usually, people with Part D can switch plans only during the annual open enrollment period.

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