| Yes, Medicare covers insulin, but how you administer your insulin determines which part of Medicare will cover it. With more than 3.3 million Medicare beneficiaries using one or more types of insulin, coverage has improved in the past few years and is even better in 2023.
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 may cover the pump and insulin, the hormone that regulates your blood sugar.
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. In 2022, more than 2,100 Part D and Medicare Advantage plans participated in a program to provide insulin with no more than a $35 copayment for each month’s supply.
Starting in 2023, all Part D and Medicare Advantage plans with drug coverage now cap insulin users’ out-of-pocket costs at $35 a month, thanks to the Inflation Reduction Act. This means the plans can’t charge you a deductible or higher copayments for insulin.
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?
You generally need to buy a private Part D prescription drug plan to have coverage for insulin. The area where you live likely has several plans to choose from, so it’s important to find out about the coverage for your specific medications. Even though all Part D plans must cap insulin copayments at $35 starting in 2023, that doesn’t mean they must cover all types of insulin.
This $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.
Plan Finder uncertainty. Despite the $35 out-of-pocket cap, comparing insulin coverage for Part D plans is more complicated than usual for 2023. The $35 limit was enacted after the plans’ pricing information was included in the Medicare Plan Finder. So you may not find the new price reflected when comparing out-of-pocket costs using Medicare’s tool.
Medicare recommends contacting your State Health Insurance Assistance Program (SHIP) or calling 800-MEDICARE (800-633-4227) to get up-to-date cost-sharing amounts for plans available in your area for 2023.
Because of these problems, Medicare is also offering a special enrollment period for people who use a covered insulin product to add, drop or change their Part D coverage one time between Dec. 8, 2022, and Dec. 31, 2023, even though it is outside the open enrollment period for 2023 plans.