Does Medicare Cover Insulin?

Medicare Part B only covers insulin if the use of an insulin pump is medically necessary.

A Medicare Advantage Prescription Drug plan (MAPD) or a standalone Medicare Part D prescription drug plan (PDP) may cover insulin, even if you don’t use an insulin pump. These plans may also cover the supplies you need to inject insulin, such as syringes, needles, gauze and alcohol swabs.

If you are an insulin-dependent diabetic, you may qualify for a type of Medicare Advantage plan called a Medicare Special Needs Plan (SNP) that covers insulin and is specifically tailored to meet the needs of people with diabetes.

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What diabetic supplies are covered by Medicare Special Needs Plans?

Medicare SNPs limit membership to people with specific characteristics or diseases, including chronic illnesses like diabetes.

The plan’s benefits, provider choices, and covered drugs are tailored to best meet the unique needs of the groups they serve.

A Medicare SNP could cover a wide range of diabetes supplies and services, such as:

  • Expanded coverage for the types of prescription medications that help treat diabetes
  • Coordinated care from providers who specialize in diabetes care
  • Nutrition therapy and medication management services
  • Clinical trials or certain alternative medicines or therapies

“In general, special-needs plan enrollees had lower admission rates, shorter average lengths-of-stay in the hospital, lower readmission rates, slightly lower rates of hospital outpatient visits, and slightly higher rates of physician office visits than their fee-for-service counterparts.” – Health Affairs1

Benefits and coverage can vary by plan. Speak with a licensed insurance agent who can help you compare plans in your area by calling TTY Users: 711 24 hours a day, 7 days a week.

Some Medicare Advantage plans cover insulin

Medicare Advantage Prescription Drug plans can cover insulin and other diabetes supplies.

Many Medicare Advantage plans can also help beneficiaries receive more coordinated care than they would receive through Original Medicare. One study in 2018 showed that people with Medicare Advantage plans experienced up to 33 percent fewer ER visits and 23 percent fewer hospital stays that people enrolled in fee-for-service Medicare.

A licensed insurance agent can help you find and compare Medicare Advantage plans and Medicare SNPs in your area and get you enrolled in a plan that works for you.

Find a Medicare Advantage plan that covers insulin

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Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.

 

1 Cohen, Robb, et al. Medicare Advantage Chronic Special Needs Plan Boosted Primary Care, Reduced Hospital Use Among Diabetes Patients. (Jan. 2012). Health Affairs(31, 1). https://doi.org/10.1377/hlthaff.2011.0998.

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