Frequently Asked Questions
How much does insulin cost under Medicare Part D?
Under the Inflation Reduction Act, insulin covered under Medicare Part D is capped at $35 per month per insulin product — regardless of which tier it's on or how much it normally costs. This cap applies to all Medicare Part D plans and to Medicare Advantage plans with drug coverage. The $35 cap began in 2023 and continues in 2026. You pay $35 or your normal cost-sharing, whichever is less.
Does Medicare Part B cover insulin?
Medicare Part B covers insulin in two specific circumstances: (1) when used in an insulin pump — the insulin is covered as durable medical equipment at 80% under Part B, not under Part D. (2) for patients who are not able to self-inject — in very limited circumstances. For most insulin-dependent seniors who inject, insulin is covered under Part D (with the $35 cap) rather than Part B.
Does Medicare cover continuous glucose monitors (CGM)?
Yes — Medicare Part B covers CGMs including Dexcom G7 and FreeStyle Libre 3 for insulin-using beneficiaries as durable medical equipment. To qualify: you must have diabetes, use insulin (injections or pump), and have your doctor write a prescription documenting medical necessity. You pay 20% coinsurance after the Part B deductible, $0 with Medigap Plan G.
Does Medicare cover insulin pumps?
Yes — Medicare Part B covers insulin pumps as durable medical equipment for qualifying diabetic patients. To qualify: you must have Type 1 diabetes or Type 2 diabetes requiring an insulin pump, your doctor must document medical necessity, and you must obtain the pump from a Medicare-enrolled DME supplier. The pump and insulin used in the pump are both covered under Part B at 80% coinsurance.
Which insulins are covered under the $35 cap?
The $35 cap applies to all insulins that are on your plan's formulary — covered insulins. If your insulin is not on your Part D plan's formulary, the cap does not apply to that specific insulin. During AEP, run Medicare Plan Finder with your specific insulin entered to verify it's covered and confirm the $35 cap applies. Most major insulins (Lantus, Basaglar, Humalog, NovoLog, Toujeo, Tresiba, etc.) are on formularies of major Part D plans.
The $35 monthly insulin cap is one of the most significant Medicare changes in decades — but many seniors with diabetes don't know how to access it or what other diabetes coverage they qualify for. This guide covers every insulin benefit available to seniors in 2026.
The $35 Part D Insulin Cap
Every Medicare Part D plan and Medicare Advantage drug plan must cap your monthly insulin cost at $35 per covered insulin product. If you use two different insulins (for example, a basal insulin and a rapid-acting insulin), each has its own $35 cap — so your maximum monthly insulin cost is $70 for two products, $105 for three, etc.
Important verification during AEP: The $35 cap applies to covered insulins — insulins on your plan's formulary. Verify your specific insulin brand is on the formulary of any plan you're considering. If it's not covered, the cap doesn't apply. Use Medicare Plan Finder and enter your specific insulin to confirm coverage before enrolling.
Part B Insulin — Pump Users
If you use an insulin pump, your insulin is covered under Medicare Part B (not Part D) as part of the durable medical equipment benefit. This means your insulin pump insulin is covered at 80% after the Part B deductible — it does not use the $35 Part D cap. The Part B insulin benefit can actually result in lower costs than Part D for some patients, depending on insulin quantity used.
Continuous Glucose Monitors (CGM)
Medicare Part B covers CGMs for insulin-using diabetics — including the Dexcom G7 and FreeStyle Libre 3. Coverage includes the device, sensors, transmitters, and related supplies. You pay 20% coinsurance after the Part B deductible. With Medigap Plan G: $0 cost for CGM.
How to access CGM coverage: Ask your doctor at your next appointment: "Am I eligible for a CGM through Medicare?" Your doctor writes a prescription with medical necessity documentation. You obtain the CGM from a Medicare-enrolled DME supplier — the supplier bills Medicare directly.
Test Strips and Supplies
Medicare Part B covers blood glucose test strips and lancets for all diabetic beneficiaries (not just insulin users). Coverage: 100 test strips per month for non-insulin users; 300 per month for insulin users. Lancets covered proportionally. A prescription and documentation of diabetes diagnosis are required. These supplies must be obtained from a Medicare-enrolled supplier.
What to Check During AEP for Insulin Coverage
- Verify your specific insulin brand is on the formulary of any plan you're considering
- Confirm the $35 cap is explicitly available for your insulin under that plan
- If you're on a pump, verify your plan covers pump supplies under Part B
- Check whether a CGM is right for you — insulin users now qualify, CGM reduces testing burden significantly
- Medicare Extra Help further reduces costs below $35 for low-income beneficiaries
- Your insulin is capped at $35/month per product under Part D — confirm it's on the formulary
- Pump insulin is covered under Part B, not Part D — different cost-sharing applies
- If you use insulin, ask your doctor about CGM coverage — it's now covered at $0 with Medigap
- Test strips are covered under Part B — 100/month non-insulin, 300/month insulin users
→ CGM Coverage — Dexcom and FreeStyle Libre
→ Complete Medicare Diabetes Guide
→ $2,100 Annual Drug Cost Cap