Medicare covers insulin, but the amount you pay depends on which part of Medicare you have and which insulin product you use

If you have Medicare and take insulin, your coverage and out-of-pocket costs are not the same across all Medicare plans. Medicare Part B covers insulin you inject yourself, including all types of insulin and insulin pens. Medicare Part D (prescription drug coverage) also covers insulin, and many people with Part D pay less than those on Part B alone. If you have Medicare Advantage (Part C), your insulin coverage depends on the specific plan you chose — some include drug coverage, some do not.

The key difference is cost. On Part B, you pay 20 percent of the approved amount after you meet your yearly deductible. On Part D, you pay a copay or coinsurance amount that varies by plan and which "tier" your insulin is on. Most people find Part D cheaper, but the only way to know your actual cost is to check your specific plan's formulary — the list of covered drugs and their prices.

Key Takeaways

  • Medicare Part B covers insulin syringes and pens, and you pay 20 percent of the approved amount after your deductible.
  • Medicare Part D covers insulin through a prescription drug plan, and your copay or coinsurance depends on which plan you chose and which insulin is on its formulary.
  • Medicare Advantage plans vary widely — some include drug coverage and some do not, so you must check your plan documents to know if insulin is covered.
  • The Medicare.gov Plan Finder tool lets you enter your insulin and see the exact cost under each plan available in your area.

How Medicare Part B covers insulin

Part B covers insulin that you inject yourself, including rapid-acting, long-acting, and combination insulins. It also covers insulin pens and the needles and syringes you use with them. You get this coverage through a supplier that Medicare has approved — you cannot just buy insulin at a pharmacy and bill Medicare.

Your cost on Part B is 20 percent of the Medicare-approved amount, after you have paid your yearly Part B deductible (which changes each year). This means if the approved amount for a month's supply is $100, you pay $20 after your deductible is met. There is no yearly cap on what you pay out of pocket for insulin on Part B alone, so if you use a lot of insulin, your costs can add up quickly.

To get insulin through Part B, you need a prescription from your doctor and you must order through a Medicare-approved durable medical equipment (DME) supplier. Your doctor can tell you which suppliers are in your area, or you can search on Medicare.gov.

How Medicare Part D covers insulin

Part D is a prescription drug plan you can add to Original Medicare (Part A and Part B), or it may be included in your Medicare Advantage plan. Part D covers insulin through retail pharmacies and mail order, which is usually faster and more convenient than ordering through a DME supplier.

Your cost on Part D depends on which plan you chose and where your insulin falls on that plan's formulary. Most plans put insulin on a higher tier, which means you pay a higher copay or coinsurance percentage — often $35 to $50 per month for a 30-day supply, though some plans charge more. A few plans cover certain insulins at a lower cost. You only pay for insulin when you actually fill a prescription, not upfront.

Part D also has an out-of-pocket spending limit. Once you and your plan have spent a certain amount on your drugs in a year, you move into "catastrophic coverage" and your costs drop significantly. This limit changes each year, but it provides a safety net if you use expensive medications.

Medicare Advantage and insulin coverage

Medicare Advantage (Part C) plans are sold by private insurance companies and must cover everything Original Medicare covers, including Part B insulin. However, not all Medicare Advantage plans include Part D drug coverage. If your plan does not include drug coverage, you cannot add a separate Part D plan — you would have to pay out of pocket for insulin or switch plans during the next open enrollment period.

If your Medicare Advantage plan does include drug coverage, your insulin costs work the same way as Part D: you pay a copay or coinsurance based on the plan's formulary. Some Medicare Advantage plans offer lower copays for insulin than standalone Part D plans, so it is worth comparing if you are shopping for coverage.

Check your plan documents or call the plan's customer service number to confirm whether your Medicare Advantage plan covers insulin and what your copay or coinsurance will be.

Using the Medicare Plan Finder to compare insulin costs

The easiest way to see what you will actually pay for your insulin is to use the Plan Finder tool on Medicare.gov. Enter your zip code, the specific insulin you take (by brand name or generic name), and the tool shows you every plan available in your area and what that plan charges for your insulin.

You will see the monthly copay or coinsurance, whether there is a deductible you have to meet first, and whether the plan has a yearly out-of-pocket limit. The Plan Finder also shows you which pharmacies in your area carry your insulin under each plan, which matters if you have a preferred pharmacy.

Run this search before you sign up for a plan or during the annual open enrollment period (October 15 to December 7 each year). Costs and formularies change from year to year, so what was cheapest last year may not be this year.

What happens if your insulin is not on your plan's formulary

If your plan does not cover the insulin your doctor prescribed, you have options. First, ask your doctor whether there is a similar insulin on your plan's formulary that would work for you. If there is, your doctor can switch your prescription and you pay the plan's copay.

If there is no suitable alternative on the formulary, you can ask your plan for an exception. This is called a "formulary exception" or "non-formulary exception." Your doctor submits a letter explaining why you need that specific insulin, and the plan decides whether to cover it. This process usually takes a few days to a week. If the plan approves the exception, you pay the copay. If it denies the exception, you can pay out of pocket or file an appeal.

Some people also use manufacturer copay information programs, which the insulin makers offer to reduce what you pay. These programs sometimes work alongside Medicare, though the rules are complex. Ask your doctor or pharmacist whether your insulin manufacturer offers information.

Insulin coverage changes and what to watch for

Medicare changes its coverage rules and drug prices shift every year. Starting in 2024, Medicare began negotiating the price of certain high-cost drugs, and insulin may be included in future negotiations. This could lower what you pay, but it also means your plan's formulary and copays may change.

Every October, Medicare sends you a notice of changes for the coming year. Read this notice carefully — it tells you whether your plan's drug coverage is changing, whether your insulin copay is going up or down, and whether your insulin is still on the formulary. If your costs are going up significantly, you have the right to switch plans during open enrollment.

You can also call Medicare at 1-800-MEDICARE to ask about insulin coverage under any plan you are considering, or to report a problem with coverage you already have.

Frequently Asked Questions

Does Medicare cover insulin pumps?

Yes, Medicare Part B covers insulin pumps and the supplies that go with them — infusion sets, reservoirs, and batteries. You pay 20 percent of the approved amount after your deductible. Your doctor must prescribe the pump and you must order it through a Medicare-approved DME supplier. Some Medicare Advantage plans also cover pumps, but you need to check your plan documents.

What if I cannot afford my insulin copay?

Contact your insulin manufacturer — most offer copay information programs that can reduce what you pay to $0 or a small fixed amount. You can also ask your doctor or pharmacist about generic insulin options, which are usually cheaper. If you are struggling financially, your local Area Agency on Aging or a 211 referral can point you to local programs that help pay for medications.

Can I use a GoodRx coupon or discount card with Medicare?

No. If you have Medicare Part D, you must use your Part D plan to fill prescriptions — using a discount card or coupon instead can cause problems with your plan's records and may affect your out-of-pocket spending limits. On Part B, you order through a DME supplier, so discount cards do not explore. Always use your Medicare coverage first.

What if I switch from Part B to Part D coverage for insulin?

You can switch during the annual open enrollment period (October 15 to December 7) or if you have a may have access to life event like moving to a new state. When you switch, there may be a gap in coverage while your new plan processes your prescription, so talk to your doctor or pharmacist about how to bridge that gap. Some pharmacies will give you a few days' supply to hold you over.

Does Medicare cover insulin that I use for weight loss?

No. Medicare covers insulin only when it is prescribed to treat diabetes. If your doctor prescribes insulin for another reason, Medicare will not cover it, and you would pay the full cost out of pocket.