Medicare coverage can be complex, especially when it comes to distinguishing what’s covered under Part B (Medical Insurance) versus Part D (Prescription Drug Coverage). This is particularly true for items like insulin pumps and related supplies.
Let’s break it down with a focus on insulin and insulin delivery systems.
Insulin Coverage Under Medicare
Medicare Part B (Medical Insurance) Covers:
- Insulin used with an insulin pump that qualifies as durable medical equipment (DME) under Part B.
- Important to note: Part B does not cover insulin pens or insulin-related supplies like syringes, needles, alcohol swabs, and gauze.
Medicare Part D (Prescription Drug Coverage) Covers:
- Injectable insulin not used with a traditional insulin pump.
- Insulin used with disposable insulin pumps.
- Certain medical supplies needed to inject insulin, such as syringes, gauze, and alcohol swabs.
- Inhaled insulin.
Your Costs with Original Medicare
- For insulin covered under both Part B and Part D, there is a cost cap of $35 per month for each covered insulin, regardless of whether you have Extra Help.
- If you purchase a 3-month supply, your cost is capped at $35 for each month’s supply — meaning you would generally pay no more than $105 total for a 3-month supply of covered insulin.
Medigap and Part B
If you have Medicare Supplement Insurance (Medigap) that covers your Part B coinsurance, your plan should cover the monthly cost of insulin under Part B (the $35 cap or less).
What About Insulin-Related Supplies?
- For supplies such as syringes, needles, alcohol swabs, and gauze, you will generally pay 100% of the cost under Part B, unless you have Part D coverage that includes these supplies.
Want to Learn More?
For a detailed comparison and helpful resources on insulin coverage, consider downloading these useful charts:
At National Insurance Markets, we help agents understand the nuances between Medicare Part B and Part D which can help your clients better navigate their coverage options and out-of-pocket costs — especially when managing conditions like diabetes that require insulin and related supplies.
