Does Medicare Pay for Insulin and Diabetes Supplies?

Medicare is a federal health insurance program for individuals aged 65 or older. It also provides coverage for younger people with certain disabilities. It covers a range of medical services and supplies.

Medicare Parts and Insulin Coverage

Medicare Part B, which is medical insurance, covers insulin when it is used with a durable medical equipment (DME) insulin pump. This typically includes external, non-disposable insulin pumps and the insulin delivered through them. Part B generally considers these pumps and the associated insulin as DME, provided they are medically necessary and prescribed by a doctor.

For most other types of insulin, coverage falls under Medicare Part D, which provides prescription drug coverage through private plans. This includes injectable insulin that is not used with a DME pump, as well as inhaled insulin. Part D plans also cover certain medical supplies necessary for injecting or inhaling insulin, such as syringes, needles, alcohol swabs, and gauze.

Insulin Costs Under Medicare

For insulin covered under Medicare Part B, such as that used with a durable medical equipment pump, beneficiaries typically pay 20% coinsurance after meeting the annual Part B deductible. However, due to recent legislative changes, the cost of a one-month supply of insulin covered by Part B is capped at $35, and the Part B deductible does not apply to the insulin itself.

For insulin covered under Medicare Part D, costs can involve deductibles, copayments, and coinsurance, which differ among individual plans. Financial assistance programs like Extra Help, also known as the Low-Income Subsidy, can significantly reduce Part D costs by helping with premiums, deductibles, and copayments for eligible individuals. Eligibility for Extra Help is based on specific income and resource limits, which are adjusted annually.

Medicare’s Insulin Savings Program

Medicare has implemented a specific program to limit out-of-pocket costs for insulin. This initiative sets a maximum monthly copayment for covered insulin products. Under this program, the cost for a one-month supply of each covered insulin product is capped at $35.

This cap applies to all Medicare Part D plans and Medicare Advantage plans that include prescription drug coverage. The Inflation Reduction Act of 2022 expanded this benefit, ensuring more consistent and affordable access to insulin for all Medicare enrollees.

Coverage for Related Diabetes Supplies

Beyond insulin, Medicare also covers various other supplies essential for diabetes management. Medicare Part B covers durable medical equipment (DME) such as blood glucose monitors, continuous glucose monitors (CGMs), test strips, lancets, lancet devices, and glucose control solutions. The quantity of test strips and lancets covered can vary, with higher allowances for individuals who use insulin. To receive coverage, these supplies must be medically necessary and obtained from Medicare-approved suppliers.

Medicare Part D plans may also cover certain diabetes supplies that are typically dispensed by pharmacies and are not covered under Part B. These can include syringes, needles, alcohol swabs, and gauze, which are used for insulin injections. The coverage for these supplies under Part D is subject to the specific plan’s formulary, deductibles, and cost-sharing structures.