In Medicare, insulin is covered under Medicare Part D, a Medicare Advantage prescription drug (MAPD) plan, or, in some cases, Medicare Part B.

Since 2023, the Inflation Reduction Act (IRA) has capped the cost of insulin for Medicare beneficiaries at $35 per month.

This means that with any Medicare plan, your out-of-pocket cost for a month’s supply of insulin is now capped at this maximum price. In addition, you don’t have to meet your plan’s deductible to get insulin at this price.

Part D is a stand-alone private drug coverage plan that you can enroll in along with Original Medicare (parts A and B). In contrast, MAPD is a Medicare Advantage (Part C) plan that bundles Original Medicare benefits and prescription drug coverage in one private plan. Both of these plans will cover a prescription for:

  • an insulin pen you can use to inject yourself
  • insulin that you would use with a disposable insulin pump
  • inhalable insulin

However, if you need to use an insulin pump that’s covered under the durable medical equipment benefit of Medicare Part B, the plan will cover the pump and the insulin it contains. In this case, since a Part C plan offers all the benefits of Part B, such a plan will also offer the same coverage.

You must be eligible and enrolled in Medicare to purchase $35 insulin with Medicare. You become eligible for Medicare at the age of 65.

You can also get Medicare earlier if you receive Social Security Disability Insurance (SSD) or if you live with either end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).

In addition, your prescription for insulin must come from a Medicare-approved doctor and be medically necessary. This is usually the case if you live with diabetes.

According to a 2020 price analysis, the average United States manufacturer price for insulin was found to be $98.70. Generally, research shows that spending on insulin has nearly tripled between 2002 and 2013, leading to reduced insulin use. The purpose of the Medicare insulin cap was to help make insulin more affordable to Medicare beneficiaries.

The IRA’s Medicare cap on insulin is nationwide. However, if you are insured by commercial health plans instead of Medicare, there may be alternative insulin caps in your state.