January 16th 2025
By Ari Parker
Does Medicare Pay For Insulin?
Find out what you'll pay for insulin with Medicare, how coverage works, and more.
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January 16th 2025
By Ari Parker
Find out what you'll pay for insulin with Medicare, how coverage works, and more.
In the US, 38.4 million people have diabetes. This equates to 11.6% of the American population.
Insulin is essential for people with diabetes, but its cost has risen dramatically. While it costs only $2 to $4 to produce a vial of insulin, the price in the US has increased from $21 in 1996 to more than $250 today.
Thankfully, Medicare Part D covers insulin. Furthermore, since January 1, 2023, costs for insulin are capped at $35 for Medicare Part D enrollees.
Medicare covers, meaning it pays for some of the cost of insulin for people with diabetes.
The 2022 Inflation Reduction Act (IRA) capped the cost of insulin copays at $35 per month (up to 30 days) for people with Medicare.
Medicare covers multiple forms and brands of insulin for people with diabetes. Insulin can be administered via injection with a syringe, an insulin pen, an insulin pump, or an insulin inhaler. Depending on how the medication is administered, insulin may be covered by Medicare Part B or Medicare Part D.
Here's a breakdown of how Original Medicare covers insulin:
Medicare Part B covers insulin delivered through an insulin infusion pump, which is considered durable medical equipment. After meeting your annual Part B deductible, you'll pay 20% of the Medicare-approved amount.
Medicare Part D covers most types of injectable and inhaled insulin. The Inflation Reduction Act of 2022 capped the monthly cost of insulin at $35 per month for Medicare beneficiaries.
Now let’s look at how Medicare Part B and Part D cover insulin and other diabetic supplies in more detail.
Medicare Part B covers the cost of insulin administered with an insulin infusion pump (but not injectable insulin). You can get a month's supply for $35 or three months for $105. You pay 20% of this Medicare-approved amount once you’ve met your Part B deductible.
Individuals with Medicare Supplement (Medigap) insurance, your plan will reduce or eliminate your out-of-pocket costs.
With a Medicare Advantage plan, your total costs for insulin coverage may vary, but you should pay no more than $35 per month due to the Inflation Reduction Act.
Medicare Part B also covers other supplies needed by older adults with diabetes. After the yearly Part B deductible, you will pay 20% of the Medicare-approved amount as long as you order supplies from a pharmacy or supplier that accepts and bills Medicare.
Covered supplies include:
Insulin pumps and pump supplies
Blood sugar or glucose testing monitors
Lancets and lancet devices
Glucose control solutions
Medicare considers these items to be durable medical equipment (or DME) and diabetic supplies.
Your plan may limit how much or how often you receive these supplies, but your doctor can prescribe more if you need more. Even diabetics who don't take insulin may need supplies like diabetic test strips, glucose monitors, or lancets.
Part D covers injectable and inhaled insulin that's not used with an insulin pump. It also covers certain medical supplies used to inject or inhale insulin, like insulin pens, inhaled insulin devices, syringes, gauze, needles, and alcohol swabs.
Part D plans are optional and have their own monthly premiums, which vary by plan. In 2025, the estimated average premium of a stand-alone Part D plan is $45/mo. You can also get Part D coverage through a Medicare Advantage plan that includes Part D coverage (commonly called an MAPD plan).
Medicare drug plans have out-of-pocket costs, such as deductibles, coinsurance, or copayments just like any other insurance plan.
Your plan will include all of the details on what it will and won’t cover.
Check your Medicare Part D plan formulary: This is a list of drugs your plan covers. You can find your formulary on your plan's website or by calling your plan's customer service number.
Ask your doctor or pharmacist: They can help you determine if Medicare covers your specific brand of insulin.
Medicare covers different types of insulin. Your doctor can help determine which type is right for you. The main types include the following:
Starts working within 15 minutes
Peaks in 1-2 hours
Lasts 2-4 hours
Examples include insulin aspart (NovoLog), insulin lispro (Humalog), and insulin glulisine (Apidra)
Starts working within 30 minutes
Peaks in 2-3 hours
Lasts 3-6 hours
One example is regular insulin (Humulin R, Novolin R)
Starts working within 1-2 hours
Peaks in 4-12 hours
Lasts 12-18 hours
An example is NPH insulin (Humulin N, Novolin N)
Starts working within 1-2 hours
Has no peak
Lasts 24 hours
Examples include insulin detemir (Levemir) and insulin glargine (Lantus, Basaglar)
Starts working within 6 hours
Has no peak
Lasts 36-42 hours
Examples include insulin degludec (Tresiba) and insulin glargine U300 (Toujeo)
In addition to these types, some premixed insulins combine rapid-acting and intermediate-acting insulin in one injection for both immediate and longer-lasting blood sugar control.
For those who can't pay the monthly insulin cost of $35, there is help available.
Medicare Extra Help program: If you have limited income and resources, this Medicare program will pay Part D premiums, deductibles, coinsurance, and other costs. Some people, such as those on SSI, Medicaid, or a state assistance program, are enrolled automatically, but anyone can apply.
Ask your healthcare provider about resources: Your physician may know about programs or coupons that can help lower the cost of insulin and even offer you samples. They can also make sure that the brand of insulin they prescribed is covered in your Part D formulary with the $35 monthly cost cap.
Check out Pharmaceutical Patient Assistance Programs: The three major US manufacturers of insulin—Novo Nordisk, Eli Lilly, and Sanofi—offer Patient Assistance Programs to help make insulin more affordable. If you meet income requirements and are on Medicare, you can get free or discounted insulin for a specific time period.
Consider State Pharmaceutical Assistance Programs: Most states have programs to help low-income seniors pay for prescription medications, including insulin. The Medicare.gov site lists programs for states with programs.
Research sites that offer substantial prescription discounts: Sites like GoodRx and SingleCare are free to join and can save you large amounts of money. You just present a printed coupon or show your smartphone at the register when picking up your insulin. You can also take a look at Cost Plus Drugs.
Investigate program matching services: Services such as GetInsulin.org and RxAssist can match you with free and low-cost insulin in your area.
See if Walmart's ReliOn™ insulin will work for you. Walmart offers an over-the-counter brand of insulin at about $25 per vial called ReliOn™. It is an older form of insulin that should be used along with a strict eating schedule. The store also has a fast-acting OTC insulin called Novolin, which is available at substantial discounts. Your doctor can advise whether either of these will work for you.
Have more questions about what Medicare covers for your diabetes? Speak with one of our Medicare Advisors, who are eager to help you understand your coverage and how to get the most out of Medicare. Get in touch by calling us at (855) 900-2427 or picking a time to chat.
