Does Medicare Part D cover Insulin?
Finding the right prescription drug coverage can be stressful. Add in the need for insulin coverage and you may find yourself overwhelmed. The good news is there is no need to stress. Medicare Part D offers a wide range of plans that provide Medicare coverage for insulin, and the best part is there’s a new program that started in 2021 that provides seniors with even more cost protection when it comes to insulin coverage. Keep reading to find out about Medicare coverage for insulin and how you can enroll in a Part D plan with insulin coverage.
Medicare Coverage for Insulin
Unfortunately, Original Medicare (Part A and Part B) doesn’t cover much when it comes to insulin. Medicare Part B (medical insurance) covers external insulin pumps and insulin if medically necessary. However, Medicare Part B does not cover:
- Insulin (except for insulin pump use)
- Insulin pens
- Alcohol swabs
If you require monthly insulin, you will need to enroll in a Medicare prescription drug plan for coverage. Medicare Part D covers all of the above items including insulin and supplies needed to administer the insulin.
Medicare Part D Costs for Insulin
The cost for insulin can vary depending on the Medicare Part D plan you choose and the coverage phase you are in. Typically there are four phases of Medicare Part D Coverage. Your cost for insulin will change depending on the phase you are in. The phases and costs include:
Deductible Phase: You are responsible for 100% of the cost of your insulin until you reach your plan deductible. The standard deductible for a Part D plan is around $445.
Initial Coverage Phase: During this phase, you are responsible for the copay amount for your insulin which is set by your Part D plan carrier. Copays can vary between drug plans. However, Insulin usually lands higher on the tier list and thus requires a larger copay.
Coverage Gap (Donut Hole): During the donut hole phase you are responsible for 25% of the cost of your insulin. For example, if your insulin costs $400 a vile you will have to pay around $100.
Catastrophic Coverage: In this phase, you are responsible for about 5% of the cost of your insulin.
Medicare Coverage for Insulin with Part D Senior Savings Model
As you can see, Insulin can be very costly even with Part D coverage. Fortunately, there is a solution. A new Medicare program called the Part D Senior Savings Model began in January 2021 and offers those enrolled in a Senior Savings Model Part D plan predictable and affordable insulin coverage. With traditional Part D coverage costs can change depending on the coverage stage however, with the Part D Senior Savings Model insulin costs are no more than $35 for a 30-day supply throughout all coverage stages. This is a huge benefit to those who require monthly insulin.
When to Enroll in Medicare Part D
It is important to be aware of your enrollment window for Medicare Part D in order to avoid a costly late enrollment penalty. You are first eligible to enroll in a prescription drug plan during your Initial Enrollment Period (IEP).
The Initial Enrollment Period is a 7-month time frame that begins 3 months before your 65th birthday, runs through your birth month, and ends 3 months after your 65th birthday.
If you miss enrolling during your IEP or decide to delay Part D coverage, you will have to pay a late enrollment penalty. The late enrollment penalty is a permanent amount that is added to your monthly Part D premium and remains in place the entire time you are enrolled in a prescription drug plan through Medicare.
If you are already enrolled in a Part D plan and wish to switch to a Senior Savings Model plan that provides predictable insulin coverage, you can do so during the Annual Enrollment Period (AEP).
AEP runs from October 15 – December 7 each year. This is also the first opportunity for individuals who missed their IEP or delayed enrollment to enroll in a prescription drug plan.