Does Medicare Part D Cover Insulin Pens?

Does Medicare Cover Insulin Pens and Needles?

Some Medicare Part D prescription drug plans or Medicare Advantage plans (Part C) that provide prescription drug coverage may cover insulin pens.

Medicare plans with drug coverage typically cover:

• Injectable insulin not used with a pump

• Inhaled insulin

• Certain diabetic supplies used to inject or inhale insulin (syringes, needles, insulin pens, alcohol swabs, and gauze)

• Anti-diabetic drugs used to maintain blood sugar

Learn more about your Medicare coverage options when it comes to insulin supplies like insulin pens.

How Much Does Insulin Cost With Medicare Drug Plans?

Medicare Part D plans and Medicare Advantage are sold by private insurance companies. Plan availability and costs may vary.

Each Medicare drug plan has its own list of covered drugs and rules for coverage, known as a formulary.

Your actual drug coverage and costs will depend on:

• The type of drugs you use

• The Medicare Part D plan or Medicare Advantage plan you enroll in

• Whether you go to a pharmacy in your plan’s network

• Whether the drugs you use are on your plan’s formulary

• Whether you get Extra Help paying your Part D costs

Be sure to speak with a licensed insurance agent to get details on:

• Whether your Part D plan or Medicare Advantage plan covers your insulin supplies

• How much these drugs will likely cost with your Part D coverage

• What network of pharmacies and suppliers your plan uses

How Do I Get Diabetes Supplies Covered by Medicare?

For most diabetic self-testing equipment and supplies, you need to get a prescription from your doctor in order for Medicare Part B to cover it.

The prescription should specify:

• That you have diabetes

• What kind of durable medical equipment (DME) you need and why you need it

• Whether you use insulin

• How often you should test your blood sugar

• How many test strips and lancets you need (per month)

You can either order and pick up your supplies at a pharmacy that’s enrolled in Medicare, or have them delivered to your home using a national mail-order contract supplier.

Original Medicare doesn't pay for a variety of insulin-delivering tools or supplies such as:

• Insulin pens

• Gauze

• Needles

• Alcohol swabs

In some cases, however, Medicare Part B may cover insulin pumps.

If a doctor states that it is medically necessary for you to use an insulin pump, the pump and the insulin supply may be covered as durable medical equipment under Medicare Part B medical insurance.

Some other diabetes equipment and supplies that are covered by Medicare Part B include the following:

• Blood sugar (glucose) test strips

• Blood sugar testing monitors

• Lancet devices and lancets

• Glucose control solutions

• Therapeutic shoes or inserts

Medicare Part B also provides coverage for some services for people with diabetes:

• Training in diabetes self-management

• Annual eye exams

• Foot exams

• Tests for Glaucoma

• Medical nutrition therapy services

In this situation, you’d pay 20 percent of the Medicare-approved amount for the cost of the insulin and pump (after you meet your Part B deductible, which is $240 per year in 2024).

Each of the 10 standardized Medicare Supplement Insurance (also called Medigap) plans available in most states cover the Medicare Part B coinsurance or copayment.

Medicare beneficiaries may have other options to get coverage for insulin pens, insulin and other diabetic supplies that aren't covered by Original Medicare.

• One option is to enroll in a Medicare Advantage plan that provides prescription drug coverage. Medicare Advantage plans are sold by private insurance companies and are an alternative to Original Medicare.

  Medicare Advantage plans are required to provide all of the benefits that are covered by  Medicare Part A and Part B. Many Medicare Advantage plans also cover prescription drugs, which are not covered by Original Medicare.

  Some Medicare plans may cover insulin pens and other diabetes supplies.

• Another option is to enroll in a Medicare Part D prescription drug plan.

  Some Part D plans may cover insulin pens, insulin and other diabetic supplies. Part D plans can be used in conjunction with Original Medicare and with Medigap plans (Medicare Supplement Insurance).

  You can compare Part D plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

Can Medicare Part B Cover Insulin?

Find Medicare Coverage for Your Insulin Pens

A licensed insurance agent can help you compare Medicare Part D prescription drug plans or Medicare Supplement Insurance plans that are available where you live.

While Medigap plans don't cover insulin or insulin pens, they can help cover some of the Medicare out-of-pocket costs that you may face if Medicare covers your diabetes supplies, such as deductibles and copays.

Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.