Insulin

NEW! Change to Medicare Part D insulin costs starting January 1, 2023.
  • Plans can’t charge you more than $35 for a one-month supply of each Medicare Part D-covered insulin you take, and can’t charge you a deductible for insulin.
  • Because this is a brand-new benefit, the new $35 cap may not be reflected in your estimated total costs when you review and compare plans.

What if I get a 60- or 90-day supply of insulin?

Your costs can’t be more than $35 for each month’s supply of each covered insulin. For example, if you get a 60-day supply of a Part D-covered insulin, you’ll generally pay no more than $70.

Note: Starting July 1, 2023 similar caps on costs will apply for insulin used in traditional insulin pumps (covered by Medicare Part B).

If you take insulin, you should get help comparing plans and costs for 2023:

    Your costs in Original Medicare

    Starting in 2023, the cost of a one-month supply of each Part D-covered insulin will be capped at $35, and you won’t have to pay a deductible for insulin. This applies to everyone who takes insulin, even if you get Extra Help.

    For insulin used with a traditional insulin pump that is covered under the Medicare durable medical equipment benefit, you pay 20% of the Medicare-Approved Amount after you meet the Part B deductible.  You pay 100% for insulin-related supplies (like syringes, needles, alcohol swabs, and gauze), unless you have Part D.

    Note:

    To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

    • 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
    Things to know

    Part D covers these:

    • Injectable insulin that isn’t used with a traditional insulin pump
    • Insulin used with a disposable insulin pump
    • Certain medical supplies used to inject insulin, like syringes, gauze, and alcohol swabs

    If you use an external insulin pump that isn’t disposable, Part B may cover insulin used with the pump and cover the pump itself as durable medical equipment (DME). If you live in certain areas of the country, you may have to use specific insulin pump suppliers for Medicare to pay for a durable insulin pump.

    Medicare Part B (Medical Insurance) doesn’t cover these:

    • Insulin (unless use of an insulin pump is  medically necessary
    • Insulin pens
    • Syringes
    • Needles
    • Alcohol swabs
    • Gauze