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.
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.
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.
Part D also covers supplies. That means you’ll foot less of the bill for items used to administer insulin, such as alcohol swabs, gauze, inhaled insulin devices, needles and syringes.
Special rules apply for external pumps. If you take insulin through a pump that’s not disposable, often a battery-operated smartphone-sized computer that delivers the hormone at scheduled times throughout the day, the pump and insulin may be covered through Medicare Part B as durable medical equipment. In this case, you’ll pay 20 percent of the Medicare-approved amount after you meet the annual Part B deductible, which is $226 in 2023.
Insulin prices to drop at midyear. Starting July 1, 2023, the cost of insulin used in the insulin pumps that Part B covers will also be capped at $35 a month.
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, you’ll pay 20 percent of the Medicare-approved costs.
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, but in 2024 the Inflation Reduction Act will expand the income levels to allow more people to qualify.
In 2023 to qualify for full Extra Help, your monthly income must be below $1,660 if you’re single or $2,239 if you’re married. For partial Extra Help, your monthly income must be below $1,843 if you’re single and $2,485 if married.
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.
Updated January 23, 2023
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