What you Need to Know About Medicare Drug Coverage for Insulin in 2021

Diabetes is a serious and common disease and it is the seventh leading cause of death nationwide and in Hawaii. Diabetes is characterized by high levels of blood glucose or blood sugar. People with diabetes are at greater risk of developing health complications such as eye disease, cardiovascular disease, and kidney disease. Proper management is vital to preventing complications and for many, that includes insulin to help regulate blood sugar.


If you have diabetes and are getting ready to transition from employer or individual health insurance to Medicare, you may be wondering about Medicare drug coverage for insulin and diabetes supplies.

Medicare Drug Coverage for Insulin


Medicare Part B is the Medical Insurance portion of Original Medicare but it doesn’t cover insulin or diabetes supplies, including needles, syringes, insulin pens, alcohol swabs, or gauze.


What does Medicare cover for insulin pumps?


Part B does cover insulin pumps and some medical supplies associated with insulin pumps. Medicare has two categories for insulin pumps: tubed and tubeless. The type of insulin pump you use will determine how much Medicare pays. Medicare Part B covers tubed insulin pumps as durable medical equipment (DME). Other supplies that may be included in this coverage with some limitations are lancet devices and lancets, blood glucose test strips, glucose testing monitors and glucose control solutions.


To get diabetes supplies covered under Medicare Part B, you will need a prescription from your doctor that specifically states that you have been diagnosed with diabetes and what kind of blood glucose monitor and test strips you need and why.


What does insulin cost on Medicare?


Original Medicare


Seniors on Original Medicare pay 100% of the cost of insulin without a pump. When used with an insulin pump, you pay 20% of the Medicare-approved amount along with the Part B deductible. In addition, you pay 100% for syringes and needles, unless you have Medicare Part D.


Original Medicare with Part D


If you have Original Medicare with Part D you will have coverage for injectable insulin that is not used with an insulin pump along with certain medical supplies used to inject the insulin such as alcohol swabs, syringes, and gauze.


New insulin savings with the Part D Senior Savings Model


Since January 1, 2021, many seniors have had access to Medicare drug coverage with a wide range of insulin types that carry a maximum cost of $35 for a 30-day supply. This coverage first became available to seniors during the 2020 Annual Enrollment Period (AEP) by joining a Medicare drug plan or Medicare Advantage Plan with drug coverage that participates in the insulin savings model. This model lets seniors choose among drug plans that offer insulin at a stable and affordable cost.


If you require insulin, you may be interested in signing up for a plan that includes this coverage. Contact a Medicare agent to discuss your options. You can join during the 2021 AEP (October 15 – December 7, 2021).


Contact a PBC Agent for Help


Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.


At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.