How Much Does Insulin Cost in Medicare?
January 27, 2023 | Gabe Taylor
What Will Insulin Cost Me in Medicare?
The cost of insulin has been a hot topic for many years. Many people have concerns about how Medicare will cover insulin in comparison to their current insurance coverage.
There are many different factors to consider, such as the Medicare coverage gap (also known as the Donut Hole) in Medicare prescription plans. (Read more: The Medicare Donut Hole: How Does It Work?)
One of the most common questions we hear is: how will Medicare prescription coverage affect my insulin costs?
Until 2023, there were two categories of questions that needed to be answered in order to determine diabetes-related costs under Medicare:
1. Is my insulin on the plan’s formulary?
Each Medicare prescription drug plan has its own “formulary,” which is the list of medications covered under that plan. Though each plan is required to cover an insulin in each category, there will be specific insulins that will or will not be covered.
Traditionally, most standard plans covered insulin under a tier 3 copayment, varying by the plan but often charging between $40-50 per month. If these insulins push you into the “coverage gap” phase of the plan, the cost may go up to much higher copays for the rest of that year.
2. Am I on a “Senior Savers” plan?
These plans will provide covered insulins at $35 per month, even when entering the “coverage gap” or “donut hole” phase of your prescription drug plan.
Insulin Cost Changes in 2023
Before 2023, certain plans were Senior Savers plans while others were not. That is changing for 2023! Now, every plan that provides prescription drug coverage must cap covered insulins at $35 copay, even while inside of the coverage gap!
In summary, the most important thing to consider when reviewing your insulin options is whether or not the insulin you want or need is on that specific Part D plan’s formulary.
Additionally note that these plans can change which medications they cover each year, so it would be wise to clarify that your insulin is still covered under that plan’s formulary. Contact Twin City Underwriters to discuss your medication coverage and whether it meets your needs.
Do you have questions about Medicare, and which plan is right for you? Twin City Underwriters offers free informational Medicare webinars and one-on-one consultations with Medicare insurance brokers where you can ask questions and get personal answers. If you need Medicare help, we can help you select the right coverage for your needs. To attend a Medicare workshop or set up an appointment, call us toll-free at 1-800-507-6778 or send us a message.