Jack's Blog on Medicare Plan Choices

By now you are aware that Medicare has capped the cost of most insulins to $35 per month.  But what about the supplies needed to use that insulin properly.  Lets talk about supplies needed to inject insulin, including syringes, needles, alcohol swabs, and gauze.

Let’s break down which part of Medicare covers what.

1. Medicare Part B:

Part B may cover syringes if you use an external insulin pump.  In this case, you would likely have a rental pump from a durable medical equipment provider.  For most people who administer insulin themselves using syringes or pens, Part B does not cover the syringes.  See below, Part D and Part C.

2. Medicare Part D:

This is the part of Medicare that typically covers insulin syringes.  Medicare requires that all Part D plans cover insulin and the associated supplies needed to inject insulin, including syringes, needles, alcohol swabs, and gauze.

3. Medicare Advantage (Part C):

If you have a Medicare Advantage plan that includes prescription drug coverage, it should cover insulin syringes similar to Part D plans.

4. Coverage details:

While Part D plans must cover insulin syringes, the specific brands, quantities, and any associated copays or coinsurance may vary by plan.  Some plans may require prior authorization or have quantity limits.

5. Recent changes:

 The Inflation Reduction Act of 2022 has introduced changes to insulin coverage, capping out-of-pocket costs for insulin products to $35 per month’s supply for Medicare beneficiaries. This may indirectly affect how plans cover associated supplies like syringes.

6. Medicaid consideration:

For dual-eligible beneficiaries (those with both Medicare and Medicaid), Medicaid may provide additional coverage or cost-sharing assistance for insulin syringes.

Here is my disclaimer. I gather most of my information from Medicare.gov and CMS.gov and to the best of my knowledge, it is accurate. Please use this information as a guideline.

Before choosing an Advantage or Supplement plan, ensure you have a thorough understanding of Medicare itself. When it’s time to explore your options, don’t fall for a sales pitch from a single company or an agent representing only one provider.
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