Diabetes is a common medical condition that affects people of all ages but is very prevalent in the senior community. According to the American Diabetes Association, around 16.5 million elderly Americans are dealing with diabetes. There are many methods people use to manage their diabetes symptoms, including taking prescription insulin to control their blood sugar levels.
If you’re on Medicare and have diabetes, you may be wondering, “Does Medicare cover insulin?” The healthcare costs Medicare covers have improved in recent years. However, you may still not know whether your healthcare plan includes diabetes medication coverage.
This blog will discuss if Medicare health plans cover the cost of insulin. We’ll also talk about what’s included in the coverage of each Medicare plan so you know what to expect.
So, does Medicare cover insulin? The short answer is yes, some Medicare drug plans provide coverage for the medication. Keep in mind that there are some exceptions to the coverage and specific criteria you need to meet.
If you have Medicare Part B health coverage, your plan will cover insulin pumps and insulin. Your plan will only cover the cost of insulin if it’s medically necessary to use an insulin pump. In these cases, the insulin pumps are classified as durable medical equipment (DME) and covered by your plan.
Medicare Part B doesn’t cover all insulin-related supplies. Some of the things it won’t pay for include:
Generally speaking, Medicare Part B usually covers the supplies and services that affect those with diabetes. You’ll have to pay 100% for your insulin if an insulin pump isn’t required for your treatment. A few of the other things Medicare Part B may pay for include:
Medicare Part C is also called Medicare Advantage. It provides similar coverage to patients as Medicare Part B. Medicare Part C requires patients to use an insulin pump for their insulin to be covered.
Medicare Part D is considered the prescription drug plan for Medicare. You’re able to purchase a drug plan that meets your medical needs through a Medicare-approved private insurance carrier. Medicare Part D may cover the costs of insulin and the medical supplies needed to inject it.
What’s great about Medicare Part D is that it’ll cover insulin that doesn’t need an insulin pump to use. It covers both inhaled and injected insulin. Other costs that you may receive coverage for under this plan include:
You’ll have to pay a monthly premium amount for Medicare Part D that’s separate from what you pay for Part B.
According to the Centers for Medicare & Medicaid Services, the Inflation Reduction Act was designed to provide insulin cost assistance for those on Medicare. This law provides patients with numerous Medicare insulin benefits, such as:
What’s great about the Inflation Reduction Act is that it sets the price of insulin at $35 per month per Medicare Part D insulin prescription.
Those with Medicare Part B coverage are included in this act. Those with that plan will also experience a $35/month cost-sharing cap on their insulin prescriptions that use a pump.
Understanding the nuances of Medicare and what coverage it provides can be confusing. Let’s go over some of our most commonly asked questions on Medicare coverage for insulin.
The $35 prescription cost cap applies to insulin products that are on your plan’s list of covered medications, also known as a formulary. A formulary is a list of generic and brand-name drugs covered by Medicare Part D.
Before you choose your healthcare plan, make sure it covers your desired insulin. Compare coverage for the rest of your medications as well.
As mentioned earlier, Medicare Part B will cover insulin and your pump if your insulin is delivered through a non-disposable pump. This includes pumps that are set up to deliver insulin at pre-determined times during the day.
Many patients worry about the cost of their insulin medication while on Medicare. Some patients will be able to save money with the Part D Senior Savings Model or the Inflation Reduction Act. Insulin costs are capped for all patients regardless of what Medicare plan they’re on.
There are many necessary services and screenings you’ll need to get each year if you’re dealing with diabetes. One of these is a diabetes screening. Your Medicare health plan may pay for two screenings during 12 months.
Your doctor may order a diabetes screening if you’re dealing with some of the following health issues:
These screenings typically include a post-glucose challenge test or a fasting blood glucose test. Your Medicare health plan may cover these screenings if your doctor deems them medically necessary.
Other diabetes-related activities that may be covered under your Medicare plan include:
During self-management training, you’ll learn about healthy ways to cope with your diabetes. This will include tips on taking insulin, which may include ways to save money.
We hope we’ve answered the question, “Does Medicare cover insulin?” The amount of coverage you receive for your insulin prescription depends on the Medicare health plan in place. Thankfully, there are laws in place that are designed to keep your out-of-pocket costs low.
Family Medicine Austin is here to help you manage your diabetes in our Austin and Leander locations. Our doctors provide our patients with the resources and education they need to manage their diabetes symptoms. Contact one of our convenient locations to schedule an appointment.
