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Q: Does Medicare Part D Cover Insulin?

Asked by Anonymous on October 13, 2017

Erica Block October 13, 2017

Medicare Part D provides coverage for a range of diabetes supplies, including insulin. The supplemental prescription drug coverage which Part D provides is critical to have if you’re a Medicare beneficiary who uses injectable insulin to manage diabetes.

With the exception of insulin pumps, which are covered as durable medical equipment under Medicare Part B, all supplies used to deliver insulin, such as syringes, needles, alcohol swabs, gauze pads, and insulin pens, are covered by Part D drug plans. However, the supplies covered under Part D include only the devices and supplies that are necessary to take insulin. Other supplies used to manage and control diabetes, such as blood sugar testing strips, will fall under the coverage of Medicare Part B.

It’s not uncommon for diabetes patients requiring insulin to end up in the Medicare coverage gap known as the “donut hole,” where they’re responsible for paying a larger percentage of the cost for insulin. When this happens, a diabetic patient’s out-of-pocket costs at the pharmacy will increase dramatically, so it’s very important for these patients to budget for its increasing cost.

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One additional community answer

  1. Medicare Part D, which is the part of Medicare that covers prescription drugs, does provide coverage for insulin. However, how well it covers your insulin and what your co-pay will be depends on which Part D plan you have, so it is important to first understand how Part D works.

    Although it is a part of Medicare, Part D is sold by private insurance companies. Those private insurance companies work within a framework provided by Medicare, and Part D plans are approved annually by CMS (Centers for Medicare and Medicaid Services). The private insurance companies that sell Part D plans must cover certain classes of medications that are defined by Medicare itself. However, the insurance companies are able to set your premiums, deductibles, formulary, and copayments. So, the copayment that you will owe for insulin is determined by what insulin you use and what Part D plan you have.

    An important step in choosing a Part D plan is comparing the plans based on what medications you use, including insulin. This allows you to pick a plan that, not only covers your specific insulin medication and dosage, but also has a manageable co-pay for that insulin.

    How to Compare Part D Plans

    Comparing Part D plans allows you to choose the most optimal plan for your current medication needs. This can be done easily on the government’s Medicare Plan Finder. On Medicare’s website, you can enter your ZIP code, medication names and dosages, and preferred pharmacy in order to get a ranked list of the plans that would give you the lowest overall annual costs. This comparison takes into account the premiums of the different plans, any deductibles the plans have, as well as what the exact co-pays will be at your pharmacy for your specific medications.

    The costs under different plans vary tremendously and most parts of the country have 20-30 Part D plans that are available. So, this is a crucial step in ensuring that you have a Part D plan that meets your medication needs.

    What Other Diabetes Supplies are Covered by Medicare

    There are some diabetes-related supplies that are not covered under Part D. These are covered under Part B. The following is a list of diabetic supplies that are covered by “original” Medicare (falls under Part B):

    Syringes for injecting insulin
    Needles for injecting insulin
    Gauze and alcohol swabs related to insulin use
    Testing strips and supplies

    If using an external insulin pump is medically-necessary, this falls under “durable medical equipment”, which is also covered by Medicare Part B. However, the insulin that is used in those pumps falls under Medicare Part D coverage, so you would still need a Part D plan to offset the costs of the insulin used in the pump.

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