Many seniors are ready for a break from the costs of their medications, specifically insulin. It can be confusing to know what Medicare covers with regard to insulin costs. Americans are rarely shocked to know that diabetes is an expensive disease since type one diabetes relies on insulin to live. Even with traditional insurance, the cost of the insulin pump, injections, and all the supplies can break the bank.
The U.S. government has now stepped in to try to lower the skyrocketing costs of supplies associated with diabetes, especially insulin. If you are on Medicare and are worried about insulin costs, then you are likely ready for some good news! Congress has passed the Inflation Reduction Act and part of that act will affect Medicare and insulin costs.
What is The Inflation Reduction Act?
In August of 2022, the House passed a large package deal called The Inflation Reduction Act. While it is a beefy act and has many moving parts, it does include help for seniors with prescription medications. Namely, Medicare and insulin costs.
How does it help seniors with Medicare and insulin costs? Medicare now has more power to negotiate prices of medications that are administered in your doctor’s office or that you purchase at a pharmacy. Drug companies are also penalized if they increase drug prices faster than the rate of inflation. This only applies to Medicare.
Additionally, Medicare Part D or your drug plan will be limited. This means that as a Medicare beneficiary in Medicare Part D, you will not pay more than $2000 a year for your medications. This provision will start in 2025. Lastly, all vaccines will be made free for all Medicare enrollees.
What Will I Pay for Insulin if I am on Medicare?
With The Inflation Reduction Act being passed, starting in 2023, Medicare beneficiaries will pay no more than $35/month for insulin when covered by your Medicare Part D drug plan. The best news is there is no deductible either with insulin costs. Medicare has always covered the cost of insulin for its beneficiaries, but there have been some out-of-pocket costs depending on the specific plan.
Medicare Part B covers insulin for people with diabetes who use insulin pumps, and Medicare Part D covers insulin for people with diabetes who take insulin injections. However, some beneficiaries may have had to pay a portion of the cost, such as a copay or deductible. Additionally, some Medicare Advantage plans may have different coverage rules for insulin.
For Medicare Part B, which covers insulin pumps, beneficiaries generally had to pay 20% of the Medicare-approved amount for the pump and related supplies, after the yearly Part B deductible was met.
For Medicare Part D, which covers insulin injections, beneficiaries typically had to pay a monthly premium, an annual deductible, and a copay or coinsurance for their insulin. The cost would depend on the specific plan and the type of insulin. The co-pay or co-insurance could range from a few dollars to several hundred dollars per month.
In addition, some Medicare Advantage plans have had different cost-sharing requirements for insulin, and beneficiaries needed to check with their plan to understand the costs.
It’s also worth noting that many states still have laws that limit the cost of insulin, and some pharmaceutical companies offer assistance programs.
How Do I Know What I Will Pay for Insulin on Medicare This Year?
As always, it is recommended that individuals check with their specific plan to understand their coverage and potential costs. If you do not have a Medicare Agent or they are not sure of your situation, reach out to MedicareInc.com. We can give you a quick phone call to assess your situation and ensure you are on the right plan!
Helping seniors with Medicare
Final Thoughts on Medicare and Insulin Costs
It can be a struggle to figure out what Medicare will cover and what you will pay when it comes to insulin and other drug-related healthcare costs. The best decision you can make with your health is to follow doctor’s orders and also work with a licensed insurance broker. Medicareinc.com helps hundreds of seniors a year get into the right Medicare plan, understand their coverage, and follow up year after year to ensure all is going smoothly. If you want an agent you can trust, look no further than MedicareInc.com.
