Does Medicare Cover Insulin?
Today in the United States, type two diabetes is the most common form of diabetes. In fact, around 25 percent of people who are older than 65 are impacted by it, and even more have pre-diabetes.
Having type two diabetes means that your body isn’t using the insulin it produces correctly, and that results in blood sugar rising above normal levels. Some people who have been diagnosed are able to control their blood sugar by eating right and getting exercise. Studies show that people with pre-diabetes can cut their risk for developing type two diabetes by 58 percent just by making lifestyle changes like eating healthy foods, exercising, losing weight, and getting proper sleep.
While those changes can help many avoid taking oral medication or insulin, there are many others who must take insulin to manage their type two diabetes. Whether you are taking insulin now, or you need to in the future, you should have an idea about how your Medicare benefits can help you cover the cost.
How does Medicare cover insulin?
Original Medicare Part B doesn’t cover insulin unless you use an insulin pump to administer your insulin.
In other words, if you don’t use an insulin pump to administer your insulin, Medicare doesn’t cover it and you pay 100 percent of the cost for your insulin (unless you have Part D coverage). If you do use an insulin pump to administer your insulin, Medicare Part B pays for 80 percent of the cost of your insulin and the insulin pump. You pay the remaining 20 percent plus your annual Part B deductible.
To be eligible for this benefit, the insulin pump you use must be a tubed pump, NOT a tubeless pump. It must also be prescribed by a physician who accepts Medicare assignment, and you must meet the following criteria to get this benefit:
- You require insulin to control your diabetes.
- Your insulin regimen requires frequent adjustments and dosage changes.
- You need to check your blood sugar frequently (at least four times per day.)
Part D coverage for insulin
If you have a stand-alone Medicare Part D (prescription drug) plan, or if you have prescription drug coverage through a Medicare Advantage (Part C) plan, your plan covers the following:
- Insulin you inject with a syringe not with an insulin pump.
- Syringes, gauze, alcohol swabs, and other medical supplies you may need with injectable insulin.
The amount you pay out-of-pocket depends on how much your individual plan charges for copayments and/or coinsurance.
Today there are many Medicare prescription drug plans that offer benefits for insulin. These plans cover different types of insulin for a maximum copayment of $35.00 per month’s supply of insulin.
What does Medicare coverage for diabetes include?
Original Medicare Part B covers 100 percent of the cost for up to two glucose laboratory test screenings every year if your health care provider finds you at risk for diabetes.
To be eligible for these diabetic screenings, you must have any of the following risk factors:
- A history of abnormal levels of cholesterol and triglycerides
- A history of high glucose levels
You may also be eligible for the yearly screenings if you have two or more of the following conditions:
- 65 years old or older
- Family history of diabetes
- History of gestational diabetes or delivering a baby weighing over nine pounds
Original Medicare Part B covers 100 percent of the cost for preventive care services like diabetes screenings if you qualify and have them done by a health care provider who accepts Medicare assignment.