7 Things to Know About Medicare Insulin Costs
1. As of January 1st, 2023, your Medicare drug plan can’t charge you more than $35 for a one-month supply of each Part-D covered insulin product, and you don’t have to pay a deductible for your insulin. You’ll pay $35 (or less) for a one-month supply of each Part-D covered insulin product, even if you get Extra Help to lower your prescription drug costs.
2. If you get a 2- or 3-month supply of Part D-covered insulin, your costs can’t be more than $35 for each month’s supply. You’ll pay $35 (or less) for a one-month supply of each Part-D covered insulin product, even if you get Extra Help to lower your prescription drug costs. For example, if you get a 2-month supply of a Part D-covered insulin, you won’t pay more than $70 for that 2-month supply.
3. If you get a Part D-covered insulin product and pay more than $35 for any month’s supply between January 1, 2023 and March 31, 2023, your Part D plan must reimburse you within 30 calendar days for the amount you paid that’s over $35 per month’s supply. (Part D plans have until March 31, 2023, to update their systems to make sure you’re charged the correct amount.) If you haven’t received reimbursement within 30 days, contact your plan.
4. If you use a covered insulin product and decide you’d like to be in a different Part D plan for 2023, you can add, drop, or change your Part D coverage one time between now and December 31, 2023. If you change plans mid-year, your True Out-of-Pocket (TrOOP) costs will carry over from your old plan to your new one. Call 1-80-MEDICARE (1-800-633-4227) if you take insulin and want to change your plan. TTY users can call 1-877-486-2048.
5. If you use a disposable insulin patch pump, you’ll continue to get your insulin through your Part D plan, and the insulin for your pump won’t cost more than $35 for a month’s supply of each covered insulin product. If your Part D plan covers disposable insulin patch pumps, the pump is considered an insulin supply. Because it isn’t an insulin product, the pump isn’t subject to the $35 cap and might cost more than $35.
6. If you use a traditional insulin pump that’s covered under Medicare Part B’s durable medical equipment benefit, the $35 cap on your insulin costs starts July 1, 2023. Beginning July 1, 2023, your cost for a month’s supply of Part B-covered insulin for your pump can’t be more than #35, and the Part B deductible won’t apply. If you have Medicare Supplement Insurance (Medigap) that pays your Part B coinsurance, that plan should cover the $35 (or less) cost for insulin.
7. Want to learn more about Medicare’s coverage and your costs for insulin?
- Visit Medicare.gov/coverage/insulin.
- Visit Medicare.gov/about-us/inflation-reduction-act.
- Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
You can also find more information regarding Medicare’s coverage for insulin in the following blogs on our website:
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