Insulin costs have always been a hot topic with our clients. Costs have historically been higher when you move to Medicare than before when you were on your group or individual plans. There always seems to be confusion on what is covered by Original Medicare Part B and what is covered by the Prescription Part D coverage.
To best answer those questions, we've compiled the below information from www.medicare.gov
Insulin
Medicare Part B (Medical Insurance) covers insulin if you use an insulin pump that's covered under Part B's durable medical equipment benefit but Part B will not cover insulin pens or insulin-related supplies like:
Syringes
Needles
Alcohol swabs
Gauze
Part D covers these:
Injectable insulin that isn’t used with a traditional insulin pump
Insulin used with a disposable insulin pump
Certain medical supplies used to inject insulin, like syringes, gauze, and alcohol swabs
Your costs in Original Medicare
The cost of a one-month supply of each Part D and Part B covered insulin is capped at $35, and you don’t have to pay a deductible for insulin. If you get a 3-month supply of insulin, your costs can't be more than $35 for each month's supply of each covered insulin. This means you'll generally pay no more than $105 for a 3-month supply of covered insulin.
Under Part D, the $35 cap applies to everyone who takes insulin, even 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 (or less) cost for 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).
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.
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