Insulin
Medicare covers insulin in different situations
Description
Insulin is a natural hormone that helps maintain healthy blood sugar levels.
Coverage details
Medicare Part B (Medical Insurance) covers insulin if you use an insulin pump that’s covered under Part B’s Durable Medical Equipment (DME) benefit. Part B doesn’t cover insulin that's self-administered using pens, disposable insulin pumps (also known as patch pumps) or the insulin used with them, or insulin-related supplies like syringes, needles, alcohol swabs, or gauze).
Where can I get covered DME items?
If you have a Medicare drug coverage (Part D) plan, 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 that are changed after 2-3 days (also called patch pumps)
- 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
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.
Other questions about insulin coverage under Part D?
Costs
- The cost of a one-month supply of each Part B- and Part D-covered insulin product is no more than $35, and you don’t have to pay a deductible for insulin. If you get a three-month supply of insulin, your costs can't be more than $35 for each month's supply of each covered insulin product. This means you'll generally pay no more than $105 for a three-month supply of covered insulin.
- Under Part D, the $35 limit applies to everyone who takes insulin, even if you get Extra Help.
- If you have Part B and Medicare supplement Insurance (Medigap) that pays your Part B coinsurance , your Medigap policy should cover the cost ($35 or less) for your insulin.
- For insulin-related supplies (like syringes, needles, alcohol swabs and gauze), you'll pay all of the costs under Part B (unless you have Part D).
Ask your doctor or healthcare provider how much your test, item, or service will cost.
Your doctor may recommend services that Medicare does not cover or offers too frequently. This could end up in additional costs for you. Make sure to ask your doctor about the reasons for these recommendations and what Medicare will actually cover.
Specific amounts you could owe depend on:
Other insurance you may have
How much your doctor charges
If your doctor accepts assignment
The type of facility
Where you get your test, item, or service