Does Medicare Cover Insulin? – Senior Affair Magazine
Yes, Medicare does cover insulin, and recent legislative changes have made it more affordable for Medicare beneficiaries. Thanks to the Inflation Reduction Act, the cost of insulin covered by a Medicare Part D plan is now capped at $35 per month for each insulin product.
The $35 Insulin Cap
Beginning in 2023, Medicare Part D plans are prohibited from charging more than $35 for a month’s supply of covered insulin. This cap applies to all insulin types listed on a plan’s formulary, regardless of the coverage phase you are in. Importantly, you do not need to meet your deductible before this cap takes effect.
Insulin Coverage Through Part B
Medicare Part B (as opposed to Part D) covers insulin that is used with an insulin pump. If you utilize an insulin pump, your insulin is categorized as durable medical equipment and is covered under Part B at 80%. This means you will be responsible for 20% of the cost after meeting the Part B deductible.
Types of Insulin Covered
| Insulin type | Typical coverage |
| Rapid-acting (Humalog, NovoLog, Fiasp) | Part D — $35/month cap |
| Long-acting (Lantus, Basaglar, Toujeo) | Part D — $35/month cap |
| Intermediate-acting (NPH) | Part D — $35/month cap |
| Insulin for use in pump | Part B — 80% coverage (DME) |
Insulin Supplies
Insulin syringes, pen needles, alcohol swabs, and insulin pumps are classified as durable medical equipment or medical supplies under Part B. Additionally, your Part D plan may cover lancets and test strips, so it’s advisable to check your plan’s formulary for specific details.
Yes, Medicare does cover insulin, and recent legislative changes have made it more affordable for Medicare beneficiaries. Thanks to the Inflation Reduction Act, the cost of insulin covered by a Medicare Part D plan is now capped at $35 per month for each insulin product.
The $35 Insulin Cap
Beginning in 2023, Medicare Part D plans are prohibited from charging more than $35 for a month’s supply of covered insulin. This cap applies to all insulin types listed on a plan’s formulary, regardless of the coverage phase you are in. Importantly, you do not need to meet your deductible before this cap takes effect.
Insulin Coverage Through Part B
Medicare Part B (as opposed to Part D) covers insulin that is used with an insulin pump. If you utilize an insulin pump, your insulin is categorized as durable medical equipment and is covered under Part B at 80%. This means you will be responsible for 20% of the cost after meeting the Part B deductible.
Types of Insulin Covered
| Insulin type | Typical coverage |
| Rapid-acting (Humalog, NovoLog, Fiasp) | Part D — $35/month cap |
| Long-acting (Lantus, Basaglar, Toujeo) | Part D — $35/month cap |
| Intermediate-acting (NPH) | Part D — $35/month cap |
| Insulin for use in pump | Part B — 80% coverage (DME) |
Insulin Supplies
Insulin syringes, pen needles, alcohol swabs, and insulin pumps are classified as durable medical equipment or medical supplies under Part B. Additionally, your Part D plan may cover lancets and test strips, so it’s advisable to check your plan’s formulary for specific details.
