Does Medicare Cover Insulin?

Kat Casna
Licensed Insurance Agent and Medicare Expert Writer
July 31, 2020

How Medicare covers insulin depends on whether you take insulin injections, use an insulin pump, or have an insulin inhaler. Each of these uses is covered by a different part of Medicare:

  • Part B (medical insurance): insulin pumps
  • Part D (prescription drug coverage): injections and inhalers
  • Medicare Advantage (Part C): insulin pumps, injections, and inhalers

Insulin pumps

Insulin pumps are worn outside the body. They deliver small, regular (basal) doses throughout the day and extra (bolis) doses at mealtimes.

Insulin pumps are durable medical equipment (DME) covered by Medicare Part B. Your doctor must attest that you need regular doses of insulin and prescribe the pump. Medicare covers 80% of the insulin and the pump after you pay the Part B deductible. You'll pay the remaining 20%.

If you have Medicare Advantage, your coverage for insulin pumps may differ. Contact your plan for details. Part D doesn’t cover insulin pumps.

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Insulin injections

If you use injectable insulin, you must enroll in a Part D plan or a Medicare Advantage plan with prescription drug coverage for Medicare to pay for this medication. In addition to the insulin itself, your plan could cover related supplies:

  • Syringes
  • Needles
  • Alcohol swabs
  • Gauze

How much Medicare pays and how much you’ll cover out of pocket depends on your plan, so contact your insurance company to learn more.

Insulin inhalers

There are many brands and types of insulin, but the top five most-used insulin products average about $31 per dose. (Doses vary by product.) More than 3 million people use these drugs.1 

The cost of these drugs has climbed nearly 8% between 2014 and 2018, but the Centers for Medicare and Medicaid Services (CMS) are working to cap these costs in 2021. Keep an eye out for more updates on 2021 Medicare plans during the Fall Annual Election Period (AEP) from October 15 to December 7.

Does Medicare cover other diabetic costs?

Yes, Medicare covers diagnosis, prevention, testing, and treatment. Learn more about how Medicare covers diabetes.

Bottom Line: Medicare typically covers insulin

If you have diabetes and require insulin, basic Medicare coverage (Parts A and B) may not cover your expenses. Part B covers insulin pumps, but you'll need Part D or a Medicare Advantage plan that includes prescription drugs to receive coverage for injectable insulin or an insulin inhaler.

Most of these plans are inexpensive, adding about $30 to your monthly Medicare premiums, but the potential for savings on insulin is tremendous. Talk to a licensed Medicare agent to find out whether Part D or Medicare Advantage might be best for you.

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Sources

  1. The Centers for Medicare and Medicaid Services, “Medicare Part D Drug Spending Dashboard & Data,” December 2019.

Content on this site has not been reviewed or endorsed by the Centers for Medicare & Medicaid Services, the United States Government, any state Medicare agency, or any private insurance agency (collectively "Medicare System Providers"). Eligibility.com is a DBA of Clear Link Technologies, LLC and is not affiliated with any Medicare System Providers.

Kat Casna
Written by
Kat Casna
Kathryn is a Medicare and geriatric specialist who has appeared on Baby Boomers, OppLoans, and Best Company. Her readers don’t need a degree in government-speak to get the right coverage because Kathryn sifts through Medicare’s parts, plans, and premiums to distill only the most useful information. Her favorite place in the world is a hammock that swings peacefully between two crabapple trees somewhere in New Mexico’s Gila National Forest.
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