Skip to main content
Medicare card and insulin vial with syringe: Medicare insulin coverage
Company

How to afford insulin on Medicare

Does Medicare pay for insulin? Find out which Medicare plan you need to get the most affordable insulin.
Lindsay Modglin, contributor to SingleCare
By | Updated on Apr. 4, 2024 Medically reviewed by Scott Dershowitz, LMSW, CMC

As of 2021, there were 16.5 million people aged 65 or older with either diagnosed or undiagnosed diabetes, according to the American Diabetes Association. The Centers for Disease Control and Prevention (CDC) reports that diabetes diagnoses among this age group more than doubled from 2000 to 2010. 

With age being a risk factor for developing Type 2 diabetes, many expect to see a trend of higher insulin use among seniors—mainly related to the increase in the senior population. It wasn’t until 2006 that Medicare began covering a portion of most prescription drugs, including insulin, for Medicare consumers diagnosed with diabetes. Prior to that, Medicare generally only paid for prescription drugs that were administered in a physician’s office or in a hospital or skilled nursing facility.

In 2021, Medicare tested a new insulin savings program for Part D plans called the Senior Savings Model. The new program offered insulin coverage at no more than $35 per month for Medicare Part D consumers with diabetes. The program ended on Dec. 31, 2023; however, the Inflation Reduction Act kept insulin copays at $35 or less for Medicare beneficiaries in 2024.

Medicare insulin coverage: Which plan do you need?

Medicare has four parts: Part A, B, C, and D. People who use an insulin pump will need Part B for insulin coverage; people who take other forms of insulin will need Part D for coverage.

Medicare Part B coverage for diabetes supplies

Those who have been diagnosed with diabetes and who also have Medicare Part B are eligible for diabetic supplies, including durable medical equipment (DME) that’s considered medically necessary.

Part B covers diabetic supplies, including:

  • Blood glucose monitors
  • Test strips
  • Lancet devices
  • Syringes
  • Control solutions for testing medical equipment
  • External insulin pumps
  • Insulin pens
  • Therapeutic shoes

Medicare Part B will also cover some supplies needed for injectable insulin, including alcohol swabs. Part B also covers prevention services for certain types of diabetes. This includes:

  • Diabetes self-management training classes
  • Screening tests related to diabetes, including A1C levels and eye exams
  • Diabetes prevention programs
  • Nutrition services
  • Annual Wellness Visits (for those who have been enrolled for at least 12 months)

“Medicare Part B will cover insulin if the use of an insulin pump is determined to be medically necessary, but otherwise, insulin is not covered [by Part B],” says Christian Worstell, senior staff writer and licensed health insurance agent with MedicareAdvantage.com. “Insulin may be covered by a Medicare Advantage or Medicare Part D plan.”

Medicare Part D coverage for diabetic medications

For Medicare coverage of insulin, you’ll need to enroll in a Medicare Part D prescription drug plan or be enrolled in a Medicare Advantage plan with prescription coverage.

Some of the most popular types of insulins are covered under Part D plans, including:

Oral anti-diabetic drugs are also included under Medicare Part D coverage, including:

In order for these medications to be covered by Medicare Part D plans, the insulin must be prescribed by a medical provider. 

Does Medicare pay for insulin?

From January 2021 through December 2023, the Part D Senior Savings Model helped Medicare beneficiaries pay a maximum of $35 for a 30-day insulin supply. This program ended on Dec. 31, 2023; however, the Inflation Reduction Act kept insulin prices capped at $35 for Medicare beneficiaries.

The total cost of your insulin, insulin pens, and insulin pumps depends on several factors:

  • Your Medicare coverage and any supplemental coverage
  • The type of insulin you’re using (brand name vs. generic)
  • How much of the medication you use each month or year
  • Whether your Medicare drug plan requires a coinsurance or copayment for this medication
  • Your income level and the state you live in
  • The pharmacy you use to fill prescriptions

Other costs to consider

In addition to paying $35 for your 30-day insulin supply, you may be responsible for Part B and D premiums.

In 2024, most people who are enrolled in Medicare Part B will pay a premium of $174.70 per month (it was $164.90 per month in 2023). However, if your income is above a certain threshold, you may have to pay more than that amount.

People on Part D will pay varying premiums, but the national base premium is $34.70 per month in 2024. Part D premiums may be higher for people with high incomes.

Thanks to the Inflation Reduction Act, Medicare beneficiaries do not have to meet their Part B or Part D deductible before reaping the benefits of the $35 or less copay for insulin. However, deductibles and normal cost-sharing structures still apply to diabetes-related products such as insulin pumps, test strips, oral diabetes medications, etc.

How to afford insulin on Medicare

Aside from the Medicare plans, there are additional coverage options that may be available to you, including assistance programs and enrollment in a Medicare supplement insurance plan.

Assistance programs

Some Medicare recipients have the option to enroll in programs that may help reduce or eliminate certain drug costs. Some of these programs include:

  • Medicare Savings Program: There are several Medicare Savings Programs that you may be eligible for.
  • Extra Help: This program was designed to assist Medicare Part D recipients with their prescription drug costs. It helps cover monthly premiums, copays, and deductibles.
  • Medicare Advantage Special Needs Plan: This tailored plan provides additional coverage for people with chronic diseases, including diabetes. Insulin costs, additional hospital days, and preventative services may be included.
  • Medicare Diabetes Prevention Program: This is a six-month program designed to provide realistic strategies and support for Medicare Type 2 diabetes patients. The program offers weekly group sessions with a trained coach and post-program support sessions. While participation doesn’t directly affect the costs of your diabetes supplies, it may help you learn ways to manage your diabetes better. Healthy lifestyle changes can reduce the effects of diabetes, prevent further health complications, and decrease diabetes supply costs over time.

Manufacturer rebates

Another way to save money on your medications is by using manufacturer rebates and coupons. These can lower or eliminate the costs of your medication copayments, yearly limits, and deductibles. Some patients may even qualify for free insulin pens. The eligibility criteria vary by program. Contact the manufacturer of your insulin to find out what savings options they offer.

Free trials or samples

Many insulin manufacturers offer free trials or free supplies of their medications. These programs are intended to help you find which medicine works best for you, but they may also help lower your costs over time.

Sometimes doctor’s offices also have free samples they can provide to get you started on a new medication, help you switch to a new medication, or if you can’t get immediate access to your insulin.

Patient assistance programs

Patient assistance programs offer free or discounted medications to those with financial difficulties. Drug manufacturers and nonprofit organizations offer these programs. Eligibility is based on a variety of factors, including income level, medical insurance status, and residence location.

In order to apply for most patient assistance programs, you must have an annual income less than or equal to 500% of the federal poverty limit. What this means is that if your income (as a one-person family) is roughly $75,300 per year—or $6,275 per month — you may be eligible for one of these programs.

However, this is not a steadfast rule. Many programs have higher or lower limits depending on your family size. The federal government has also been considering reducing discounts given to those with incomes as high as 400% of the federal poverty limit.

Applying for these programs can be time-consuming and frustrating, but they are worth investigating if you are struggling to afford your diabetes supplies. You can also speak with a licensed insurance agent about your options.

Prescription discount cards

Prescription drug discount cards may lower your copayment for certain medications; however, they often do not apply to your deductible or out-of-pocket maximum. You typically cannot use a prescription discount card in addition to Medicare—you have to choose one or the other.

Take advantage of SingleCare for prescription drug savings of up to 80%. If you have a preferred pharmacy, you can use a prescription discount card here, or else you can shop around to find the best price for your insulin (or other prescription drugs). Just search for the drug on singlecare.com, enter your zip code, and find the coupon with the lowest price.

Sources