Does Medicare Part D Pay for Insulin?

Medicare Part D is a standalone prescription drug coverage plan for Medicare beneficiaries. Part D is available for people of age 65 or older and younger people with certain disabilities or End-Stage Renal Diseases. It is sold by private insurance companies and it is not mandatory to have this type of insurance, but it is available for all beneficiaries who have Original Medicare (Parts A and B).

Every Part D plan has a formulary that contains the list of covered prescription medications. The drugs covered in prescription drug plans are divided into different tiers, which include generic and brand-name medications. Part D will always cover the various prescription medications that belong in categories such as anticonvulsants, antipsychotics, immunosuppressants, anticancer, antiretrovirals, and antidepressants. Each of those Part D plans has its formulary and a list of medications they are covering. All plans must cover determined categories of medications but specific drug prescriptions in each category can vary from plan to plan.

But will Part D cover insulin? Well, that ultimately depends on the equipment needed and how the insulin is given.

Medicare Part D and Insulin Coverage

Medicare Part D plans are required to cover injectable insulin. However, external insulin pumps may be covered under Medicare Part B if they are prescribed by a doctor, as a part of durable medical equipment. Medicare Part D coverage includes insulin pens, syringes, needles, alcohol swabs, and gauze.

Now, suppose you want to enroll in a Medicare Advantage plan which offers a bundle of coverage, including prescription drug coverage. In that case, you can enroll in an Advantage plan that includes Part D coverage, but before you make a decision, make sure that the insulin prescribed by your doctor will be covered.

If insulin is covered under Medicare Part D, there is still variation in tier placement and cost-sharing requirements when beneficiaries enter the initial coverage phase of their Part D policy. A large number of plans placed insulin products on Tier 3, the preferred drug tier, with a $47 copayment per prescription during the initial coverage phase.

You can also get assistance from the Medicare Part D Extra Help Program. If you have full benefits from Extra Help, your copayment for insulin will be lower than usual. Extra Help is an assistance program for Medicare Part D insurance plans. If you have a low income and are not able to cover limits that are set annually, you are suitable for Medicare Part D Extra Help. If you are enrolled in a state insurance program like Medicaid which is designed to help those with lower income status, you are immediately eligible for Extra Help. Extra Help gives assistance with monthly premiums reduction and lower copayments and coinsurance on medications.

What About Part B?

If you are also enrolled in Part B, you can get coverage for:

  • Blood sugar test strips and monitors
  • Lancets
  • Glucose control solutions
  • Screenings
  • Foot exams and therapeutic shoes
  • Nutrition therapy

Medicare Part B will also only cover insulin if it’s used with an external pump.

For more information about insulin coverage through the different parts of Medicare, reach out to Temmen Insurance today. We specialize in Medicare and simplify the process by making suggestions based on your needs.Β 

Give us a call today at (417) 633-7200 to learn more about your Medicare options!

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