Did you know that your insulin could be covered by Medicare this year? You may be able to get Medicare drug coverage that offers broad access to many types of insulin for no more than $35 for a 30-day supply. You can get these savings on insulin if you join a Medicare drug plan (Part D) or Medicare Advantage Plan with drug coverage that participates in the insulin savings model. This model lets you choose among drug plans that offer insulin at a predictable and affordable cost.
Medicare Part B (Medical Insurance) doesn’t cover these:
- Insulin (unless the use of an insulin pump is medically necessary )
- Insulin pens
- Alcohol swabs
Your costs in Original Medicare
You pay 100% for insulin (unless used with an insulin pump, then you pay 20% of the Medicare-approved amount, and the Part B deductible applies). You pay 100% for syringes and needles unless you have Part D.
Medicare Part D and insulin coverage
Part D is a private, government-regulated plan that covers prescription drugs, including your insulin and other diabetes-controlling drugs. Besides medications, you will need supplies to administer the insulin.
Part D coverage may include all of the things Part B does not like insulin pens, syringes, needles, alcohol swabs, gauze.
Whether you have a stand-alone Medicare Part D plan or a Medicare Advantage Prescription Drug plan, you may have to pay a deductible, copays, and coinsurance. Everything depends on the plan you select. Particularly as an insulin user, make sure your plan covers your doctor-prescribed insulin or includes it as an exception.
Getting your insulin covered
Pricing your medications can get very complicated. Each Part D plan has a different list of drugs it covers, called a formulary. It also assigns each medication, from generics to high-cost specialty drugs, to a pricing tier. So if you take several medications, this makes comparing plans a challenge.
Medicare Drug Plans have many variables due to the many medical needs one might have. It is all about understanding your medical needs and finding the best plan according to those needs. Before making a decision, be sure to:
- Get details on how much your drugs would cost under each plan, monthly and throughout the year.
- See which plans put restrictions on any of your drugs (meaning you have to get permission for the plan to cover them) and which offer “preferred” pharmacies that charge lower copays.
- See how Medicare has rated each plan for service (on a scale of one to five stars).
- See alerts that flag low-performing plans.
- Find out which plans are available nationally.