Insulin
covers insulin if you use an insulin pump that's covered under Part B's benefit. Part B doesn’t cover insulin pens or insulin-related supplies like:
- Syringes
- Needles
- Alcohol swabs
- Gauze
If you have a plan, it may cover:
- Injectable insulin that isn’t used with a traditional insulin pump
- Insulin used with a disposable insulin pump
- Certain medical supplies used for insulin injections, like syringes, gauze, and alcohol swabs
- Insulin that's inhaled
Your costs in Original Medicare
- The cost of a one-month supply of each Part D- and Part B-covered insulin product is capped at $35, and you don’t have to pay a 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 cap 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 $35/month (or less) cost 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).
Learn more about insulin costs under Part D and Part B.
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
If you use an 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.