Does Medicare Cover Insulin?
Key Takeaways
- Medicare covers insulin for the treatment of diabetes, most often through a Part D drug plan that is added onto Original Medicare or is a part of a Medicare Advantage plan.
- On Medicare, the maximum copayment for a 30-day supply of insulin is $35.
- Part B of Original Medicare covers insulin for the small percentage of older adults who administer insulin via an insulin pump.
- Generally, Part B covers supplies that measure what insulin levels you need, while Part D covers supplies needed to administer insulin.
Insulin is a naturally occurring hormone that helps release the energy your body needs to function properly. Many people with diabetes need insulin injections, which usually are covered by Medicare Part D as a part of Original Medicare or a Medicare Advantage plan.
Medicare Parts A and B (Original Medicare) usually don’t cover injectable insulin, but you need to have at least Part B to add Part D, and you need Parts A and B to switch to Medicare Advantage.
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What Medicare Plan Covers Insulin?
In most cases, insulin is classified by Medicare as a prescription drug, which is why Medicare Part D most commonly covers it.
Part D can be added to Original Medicare and is included in most Medicare Advantage plans.
Part D is the name given to drug coverage provided by private insurance companies under guidance from Medicare. You must have Part B (“medical insurance”) to add a Part D plan.
Nearly everyone with Part B also carries Part A (“hospital insurance”), in part because 99% of people don’t have to pay a monthly premium for Part A. Parts B and D typically require a monthly premium.
If you have Parts A and B of Original Medicare, you can switch to a Medicare Advantage plan (Part C). All Medicare Advantage plans feature at least the same coverage as Parts A and B, including Part D and other coverages not offered by Original Medicare. Some Medicare Advantage plans also reduce the monthly premiums you may owe.
What Medicare Plan Covers an Insulin Pump?
When it comes to Medicare insulin coverage, you should note that while Part D typically provides valuable coverage for diabetes patients, Part B does much of the heavy lifting for people who use an insulin pump. In that case, Part B covers the insulin used as well as the insulin pump itself.
An insulin pump is a piece of durable medical equipment attached to your body that injects insulin on a set schedule. Insulin pumps are primarily used by people with type 1 diabetes, which make up 5-10% of all diabetes patients.
How Much Does Medicare Pay for Insulin?
If you’re hoping for good news about insulin prices, you’ve come to the right place.
As of July 1, 2023, the highest you’ll pay for a one-month supply of insulin covered by Medicare is $35. That applies to injectable insulin covered by a Medicare Part D prescription drug plan as well as insulin administered through a pump, which is covered under Medicare Part B, and insulin that’s covered by a Medicare Advantage plan.
If you receive Extra Help to lower your prescription drug costs under a Part D plan and you purchase a three-month supply of insulin, the total cost to you can’t be more than $105.
Beyond insulin pumps, Part B does offer some coverage for anyone with diabetes or in danger of becoming diabetic:
- Part B covers a once-per-lifetime health behavior change program aimed at preventing diabetes. If you are at risk of diabetes, Part B may cover up to two annual diabetes screenings. Neither the behavior change program nor the screenings cost you anything if you’re eligible (though you may have to pay for the doctor’s visits for the screenings).
- If you have diabetes, whether you use insulin or not, Part B covers home glucose monitors and supplies you use with the equipment, including test strips, lancet devices and lancets. You pay your deductible and 20% coinsurance.
- Part B may pay for self-management training services (minus your deductible and 20% coinsurance).
- Part B also may cover testing related to conditions common in people with diabetes, like glaucoma and neuropathy (minus your deductible and 20% coinsurance).
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Does Medicare Part D Cover Insulin Pens?
While Part B covers many of the supplies used to gauge how much insulin you need, Part D covers insulin pens and other supplies used to deliver insulin to your body.
Part D typically covers:
- Insulin pens, with or without insulin.
- Inhaled insulin devices, with or without insulin.
- Syringes and needles.
- Cotton swabs and gauze.
Are There Different Types of Insulin?
The type of insulin you use can affect your body’s reaction, because not all types of insulin are the same. There are human insulins, called traditional insulins, and another type is analog insulin. Analog insulin is human insulin but it usually undergoes a genetic alteration that affects the properties of the insulin.
What does that mean?
The alteration of the insulin can impact things like how long the drug works in your body, how fast the insulin begins to take effect in your body, and how well it works in your bloodstream.
The different types of insulin also have an impact on how you receive the insulin and how much you pay for the insulin. In some cases, you may receive one type of insulin in a vial and other types may be administered with an insulin pen. With traditional insulins, you have many options for generic versions, which can cost a fraction of brand-name insulins.
How insulin reacts within your body is also an important consideration. Here are four types:
- rapid-acting insulin
- short-acting insulin
- intermediate-acting insulin
- long-acting insulin
What type of insulin lasts the longest?
The baseline insulin used to manage type 1 and type 2 diabetes is called NPH insulin (Humulin N, Novolin N). NPH is an intermediate-acting insulin that begins to work in the bloodstream one to three hours after it’s administered.
Tresiba is the longest-acting insulin available, according to the website GoodRx.com. Tresiba can last as long as 40 hours after being administered. However, the effect of insulin can only be considered on an individual basis, and should always be discussed with your doctor.
Are There Risks with Starting to Use Insulin at an Older Age?
The Centers for Disease Control and Prevention estimates that 21.4% of Americans age 65 and older have been diagnosed with diabetes (2013-16).
Many people have diabetes before turning 65. The risk of diabetes increases with age simply because of the impact of nutrition and lifestyle choices over time. Because of this and the fact that many people don’t rely on insulin when first diagnosed, a significant population starts using insulin later.
While the effects of insulin on diabetes appear to be a positive rather than a negative regardless of age, older adults using insulin for the first time face a learning curve. According to the National Institute on Aging, older people with diabetes are at greater risk for cognitive impairment, and the effectiveness of insulin treatments relies on patients remaining on top of all aspects of their treatments.
Does Aging Affect Diabetes and Insulin?
Your Medicare coverage is essential for managing diabetes. As older adults continue aging, managing diabetes can become more difficult. One reason diabetes management can become more challenging is insulin resistance. With age, glucose tolerance in the body decreases and insulin resistance increases.
The aging process can also affect a person’s memory and attention. Access to insulin and diabetes resources is critical for beneficiaries that must determine their insulin doses. Blood glucose monitoring can be a challenge for older adults with diabetes. However, managing your insulin doses and monitoring your levels is necessary to avoid hypoglycemia.
If you’re on Medicare and are preparing to get insulin treatment for the first time, make sure your doctor equips you with the tools needed for success.
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Sources
- Insulin. Medicare.gov.
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