Does Medicare Cover Insulin Pens?

Insulin pens are covered by some Medicare Part D prescription drug plans and Medicare Advantage plans (Part C) that offer prescription drug coverage.

If you’re eligible for Medicare and require the use of insulin to manage chronic diabetes, you may qualify for a Medicare Special Needs Plan (SNP).

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What Medicare plans cover insulin?

There are several types of Medicare plans that may cover insulin and insulin injection devices such as insulin pens:

  • Medicare Part D prescription drug plans
    Medicare Part D plans are standalone Medicare prescription drug plans that are sold by private insurance companies and cover certain prescription medications. Medicare Part D plans can offer syringes, needles, alcohol swabs, gauze, inhaled insulin devices and other diabetes supplies.

  • Medicare Advantage Prescription Drug plans (MAPDs)
    A Medicare Advantage Prescription Drug plan offers Medicare Part A hospital insurance, Part B medical insurance and Part D prescription drug coverage into one convenient plan. An MAPD plan could cover your insulin pens as well as some additional health services and benefits, including:
    • Home-delivered healthy meal options
    • Vision, hearing and dental coverage
    • Membership to SilverSneakers and other fitness and wellness benefits

  • Medicare Special Needs Plans (SNPs)
    Medicare SNPs are a type of Medicare Advantage plan that limits membership to people with specific characteristics or diseases, including diabetes. These plans offer tailored benefits, provider choices and drug formularies to best meet the specific needs of the groups they serve.

    Even better, every Medicare SNP must provide coverage for prescription drugs, and some plans include $0 premiums.

    To qualify for a Medicare SNP, you must get a note from your doctor confirming that you have the condition (in this case, diabetes) addressed by the Special Needs Plan.

Medicare Part B will only cover insulin when the use of an insulin pump is deemed medically necessary. Medicare Part A doesn’t cover insulin or insulin injection devices.

What diabetic supplies are covered by Medicare?

Medicare Part B covers several different diabetes supplies and services.

Because Medicare Advantage plans are required to cover the same benefits as Medicare Part A and Part B, the following benefits are also available with a Medicare Advantage plan or a Medicare SNP (Medicare Advantage and Medicare SNPs may offer even more benefits than what are listed below):

  • Diabetes self-management training (DSMT) service
  • Blood sugar test strips
  • Blood sugar monitors and continuous glucose monitors (CGMs)
  • Lancets and lancet devices
  • Foot exams and treatment every 6 months for people with diabetic peripheral neuropathy
  • Glaucoma tests every 12 months
  • External durable insulin pumps and insulin that is used in the pump
  • Medical nutrition therapy (MNT) services
  • Diabetic shoes or shoe inserts for people who have severe diabetic foot disease

How much do insulin pens and other diabetes supplies cost?

For insulin supplies and services covered by Medicare Part B, you typically pay a Part B copayment (20 percent of the Medicare-approved amount) after you meet your Part B deductible ($185 per year in 2019).

Medicare Special Needs plans and Medicare Advantage Prescription Drug plans have some out-of-pocket costs, such as deductibles, copayments and coinsurance. The specific out-of-pocket amounts can vary from plan to plan, sp be sure to compare plans in your area and ask about these costs.

A licensed insurance agent can help you find and compare Medicare Advantage plans in your area that may include coverage for insulin pens and other diabetes supplies.

Find a Medicare Advantage plan that covers insulin pens

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

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MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

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