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Insulin Coverage and Medicare Part D

Not Covered by Medicare

Coverage

Medicare Part B (Medical Insurance) doesn’t cover these:

  • Insulin (unless the use of an insulin pump is medically necessary)
  • Insulin pens
  • Syringes
  • Needles
  • Alcohol swabs
  • Gauze

Costs

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.

What to Know

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.

Medicare By State

Medicare is regulated by the federal government. However, private insurance companies are allowed to offer various parts of Medicare, and these plans can differ from state to state.

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