Does Medicare cover insulin?

Which part of Medicare covers insulin?

Medicare covers insulin under Part B or Part D, depending on how you take it. Medicare Part B covers insulin if you use an insulin pump that's covered under Part B's durable medical equipment (DME) benefit, meaning an external pump that isn't disposable. Part B may also cover the pump itself as DME. If you live in certain areas of the country, you may have to use specific insulin pump suppliers for Medicare to cover a durable insulin pump.

If you have a Medicare drug plan (Part D), it may cover:

• Injectable insulin (insulin you inject with a pen or a needle)
• Insulin used with pumps that aren't covered as DME under Part B, like disposable pumps changed after 2-3 days (patch pumps) and certain reusable pumps that use disposable insulin cartridges
• Insulin that's inhaled
• Certain medical supplies used for insulin injections, like syringes, needles, gauze and alcohol swabs

How much does insulin cost with Medicare?

Under Medicare Part B and Part D, a one-month supply of each covered insulin product costs no more than $35, and you don't have to pay a deductible for insulin. If you get a three-month supply, your costs can't be more than $35 for each month's supply of each covered insulin product, so you'll generally pay no more than $105 for three months.

Under Part D, the $35 limit applies to everyone who takes insulin, even if you get Extra Help, a Medicare program that helps people with limited income and resources pay Part D costs. With Extra Help, you'll pay less than $35. See help paying for Medicare costs.

Does Medicare cover insulin pumps and supplies?

Medicare Part B may cover an external insulin pump that isn't disposable as durable medical equipment, along with the insulin used in it. A Part D plan may cover certain disposable pumps, but some pumps, like patch pumps, might cost more than $35 because they aren't an insulin product covered under the $35 limit.

Part B doesn't cover insulin-related supplies like syringes, needles, alcohol swabs and gauze, so you pay all of those costs unless you have Part D. A Part D plan may cover these supplies; you pay a coinsurance or copayment, and the Part D deductible may apply.

Does Medigap or Medicare Advantage change what I pay for insulin?

If you have Part B and a Medigap (Medicare Supplement Insurance) policy that pays your Part B coinsurance, your Medigap policy should cover the cost ($35 or less) for insulin covered under Part B.

If your insulin is covered under a Medicare Advantage Plan (Part C), you also pay no more than $35 for a one-month supply and no deductible for your insulin. Medicare Advantage plans must cover all medically necessary services that Original Medicare covers, and most include Medicare drug coverage; other rules and costs vary by plan.

Does Medicare cover other diabetes drugs?

Yes, Medicare Part D plans cover a variety of diabetes drugs, and you can check with your plan to find out which ones it covers. You pay a coinsurance or copayment, and the Part D deductible may apply. Medicare is also negotiating the prices of certain expensive brand-name drugs without competition, including drugs to treat diabetes; see which drugs have Medicare negotiated prices.