Insulin Coverage for Medicare Patients

Insulin Coverage for Medicare Patients

If you have diabetes, you understand how expensive medical treatments and medications can be, especially for insulin. In 2017, diabetes became the most costly chronic disease in the country by costing the U.S. $327 billion. Insulin costs topped out at an estimated $48 billion, which is the total cost from an estimated 3.8 million people who use insulin. Because of these costly amounts, about one-fourth of diabetic patients ration their insulin supply because they cannot afford more. With this in mind, let’s look at how Medicare provides coverage for those with diabetes.

What does Medicare cover?

Medicare Part D, or the prescription drug plan, may cover insulin and certain supplies that can be used to inject the insulin. Medicare Part B will also cover necessary screenings that determine if you’re at risk for diabetes or are pre-diabetic. You are eligible for up to two screenings each year, such as a fasting blood glucose test.

If you are diagnosed with diabetes, then Medicare will cover supplies such as blood sugar testing monitors and blood sugar testing strips. If you develop foot disease issues because of diabetes, Medicare will also cover foot exams and therapeutic shoes. It’s also possible to have nutrition therapy covered if your doctor refers it.

What does Medicare NOT cover?

If you have Medicare Part B, you must know that insulin pens, syringes, needles, alcohol swabs, and gauze are not covered. However, coverage is possible under Medicare Part D.

Insulin will only be covered if an insulin pump is medically necessary. The pump will then be considered durable medical equipment. In that case, you will only have to pay 20% of the Medicare-approved amount.

Changes to insulin costs?

On March 11, 2020, it was announced that standalone plans within Medicare Part D and Medicare Advantage are working on offering lower insulin costs in 2021. The plan is to provide insulin at a maximum copay of $35 each month through the Part D Senior Savings Model.

The Part D Senior Savings Model is a new model created by the Centers for Medicare and Medicaid Services (CMS). It is meant to provide the service of lowering prescription drug costs and offer new options with Part D plans to make insulin more affordable. It’s estimated that for anyone who uses insulin and chooses to participate in the new model could see over $400 in out-of-pocket savings.

At Reichardt Insurance, we can save you the time and money by helping you decide on the Medicare plan that’s right for you. Give us a call at (870) 698-2928 and set up an appointment today.

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