Insulin
Medicare covers insulin in different situations
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. If you use an insulin pump that isn’t disposable, Part B may cover insulin used with the pump and the pump itself as DME.
Part B doesn’t cover insulin pens, or insulin-related supplies like:
- Syringes
- Needles
- Alcohol swabs
- Gauze
Where can I get covered DME items?
If you have a Part D plan, it may cover:
- Injectable insulin (insulin you inject with a pen or a needle)
- Insulin you use with pumps that aren't Durable Medical Equipment (DME), like:
- Pumps that are typically changed after 2-3 days (like patch pumps)
- Reusable pumps that use disposable insulin cartridges
- Infusion pumps
- Certain medical supplies used for insulin injections, like syringes, needles, gauze, and alcohol swabs
- Insulin that's inhaled
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 D- and Part B-covered insulin product is limited to $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, ever if you get Extra Help.
- If you have Part B and Medicare supplement Insurance (Medigap) that pays your Part B coinsurance , your plan should cover the cost ($35 or less) for each covered insulin.
- For insulin-related supplies (like syringes, needles, alcohol swabs and gauze), you'll pay 100% of the cost 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