Medicare covers insulin pens, but the amount you pay depends on which Medicare plan you have

If you take insulin, Medicare Part B covers the insulin itself and the pens you use to inject it. However, you will pay a share of the cost — how much depends on whether you have Original Medicare, a Medicare Advantage plan, or both. The coverage rules are the same whether you use a brand-name pen like a NovoLog FlexPen or a generic version.

Original Medicare (Part A and B) covers insulin pens as durable medical equipment. You pay 20 percent of the approved amount after you meet your Part B deductible. If you have a Medigap or Medicare Advantage plan, your out-of-pocket cost may be lower, but the rules vary by plan. Many people find that their actual cost is lower than 20 percent because Medicare's approved amount is often less than the pharmacy's list price.

Key Takeaways

  • Original Medicare Part B covers insulin pens at 80 percent after you meet your annual deductible, meaning you pay 20 percent of the approved cost.
  • Medicare Advantage plans cover insulin pens but set their own copays or coinsurance amounts, which may be lower or higher than Original Medicare.
  • You do not need a separate prescription for the pen itself — it is covered under the same prescription as your insulin.
  • If your insulin pen costs more than Medicare's approved amount, you are responsible only for your share of the approved amount, not the difference.
  • Insulin needles and lancets for blood sugar testing are covered separately and have their own cost-sharing rules.

How Original Medicare Part B covers insulin pens

Under Original Medicare, insulin pens are classified as durable medical equipment, which means Medicare pays 80 percent of the approved amount and you pay 20 percent. This applies after you have paid your Part B deductible for the year — in 2024, that deductible is $240, though it changes annually.

The "approved amount" is what Medicare decides the pen is worth, not what your pharmacy charges. If your pharmacy charges $150 for a pen but Medicare's approved amount is $100, you pay 20 percent of $100 ($20), not 20 percent of $150. This is one reason your actual out-of-pocket cost is often lower than you might expect.

You do not need to do anything special to get this coverage. When you fill your insulin prescription at a pharmacy that accepts Medicare, the pharmacist will bill Medicare directly. Your pharmacy will tell you what your 20 percent share is at the time you pick up your medication.

Medicare Advantage plans and insulin pen coverage

Medicare Advantage plans (Part C) must cover insulin pens because federal law requires them to cover everything Original Medicare covers. However, each plan sets its own copay or coinsurance amount. Some plans charge a flat copay — for example, $10 or $15 per pen — while others charge a percentage of the cost.

Your out-of-pocket cost under a Medicare Advantage plan depends on which plan you chose and whether your insulin pen is on the plan's formulary (the list of covered medications). Most common insulin pens are on formularies, but some newer or brand-name versions may not be. If your pen is not on the formulary, the plan may not cover it, or may require you to try a different insulin first.

Check your plan's formulary before you refill your prescription, especially if you are switching plans during open enrollment. You can find your plan's formulary on your plan's website or by calling the customer service number on your insurance card.

What happens if you have both Original Medicare and a Medigap plan

If you have Original Medicare and a Medigap (supplemental insurance) plan, the Medigap plan may pay some or all of your 20 percent coinsurance. Which Medigap plan you have determines how much it covers. Plans C, D, G, and M cover the Part B coinsurance, meaning Medigap would pay your 20 percent share after you meet the Part B deductible. Plans K and L cover a percentage of the coinsurance rather than all of it.

Your pharmacy will still bill Medicare first, then bill your Medigap plan for the amount Medicare did not cover. You should not have to pay anything out of pocket at the pharmacy if your Medigap plan covers coinsurance — but always check your Medigap plan documents to confirm.

Insulin needles and other diabetes supplies

Insulin pens are covered, but the needles you use with them are covered separately under a different rule. Medicare Part B covers insulin needles (also called pen needles) at 80 percent after your deductible, just like the pens themselves. You can get up to 100 needles per month.

Blood sugar testing supplies — lancets, test strips, and glucose meters — are also covered under Part B, though Medicare limits how many you can get per month based on how often you test. If you test your blood sugar four times a day, Medicare covers up to 120 test strips and 120 lancets per month. These limits are lower if you test less often.

Some Medicare Advantage plans cover more testing supplies than Original Medicare does. If you use more supplies than Medicare's standard limits, ask your plan whether it covers additional strips and lancets.

Using mail-order and online pharmacies with Medicare

You can fill insulin pen prescriptions through mail-order pharmacies, online pharmacies, or your local pharmacy — Medicare covers the insulin the same way regardless. However, mail-order and online pharmacies have different rules about how much you can order at once and how often you can refill.

Most mail-order pharmacies require you to order a 90-day supply, which means you pay your coinsurance or copay once every three months instead of once a month. This can lower your total out-of-pocket cost if you are paying a copay, though it does not change your coinsurance percentage under Original Medicare.

Before you switch to a mail-order pharmacy, confirm that it is in-network for your plan. Out-of-network pharmacies may charge you more, and some Medicare Advantage plans do not cover mail-order prescriptions at all.

What to do if your insulin pen is not covered or costs too much

If your pharmacy tells you that your insulin pen is not covered, or if your out-of-pocket cost is higher than you expected, you have several options. First, ask your pharmacy whether a generic or lower-cost insulin is available. Many insulins have generic versions that cost less and are covered the same way.

If you have a Medicare Advantage plan and your insulin is not on the formulary, you can ask your doctor to request an exception. This is called a formulary exception or prior authorization. Your doctor submits a form to the plan explaining why you need that specific insulin, and the plan decides whether to cover it. This process usually takes a few days to a week.

If you have Original Medicare and the cost is still too high, ask your pharmacy whether the insulin manufacturer offers a patient information program. Many insulin makers provide free or reduced-cost insulin to people who cannot afford it, regardless of income. Your pharmacy or doctor's office can help you find these programs.

Frequently Asked Questions

Do I have to pay my Part B deductible before Medicare covers insulin pens?

Yes. You must meet your Part B deductible ($240 in 2024) before Medicare starts paying its 80 percent share of any Part B service, including insulin pens. Once you meet the deductible, Medicare pays 80 percent and you pay 20 percent for the rest of the year. If you have a Medigap plan that covers coinsurance, it will pay your 20 percent after the deductible is met.

Can I get insulin pens through the mail from Medicare?

No, Medicare does not mail insulin pens directly. You order them through a pharmacy — either your local pharmacy, a mail-order pharmacy, or an online pharmacy. Medicare covers the cost the same way regardless of where you fill the prescription. Some mail-order pharmacies require a 90-day supply order, which may lower your copay frequency if you have a Medicare Advantage plan.

What if I use an insulin pump instead of pens?

Insulin pumps and the insulin cartridges that go in them are covered by Medicare Part B as durable medical equipment, with the same 20 percent coinsurance after your deductible. However, pump coverage is more complex because you need prior authorization from Medicare before you can get one. Your doctor must submit a request showing that you have tried other insulin methods first.

Does Medicare cover the cost of storing insulin pens in a refrigerator?

No, Medicare does not cover refrigerators or other storage equipment. However, insulin pens can be kept at room temperature for up to 28 days once you start using them, so you do not always need refrigeration. If you travel or have limited refrigerator space, ask your pharmacist about room-temperature storage options.

What happens to my insulin coverage if I switch from Original Medicare to a Medicare Advantage plan?

Your insulin will still be covered, but your out-of-pocket cost may change. Medicare Advantage plans set their own copays and coinsurance amounts, and they may have different formularies. Before you switch plans, check whether your current insulin is on the new plan's formulary and what your copay will be. You can make changes during the annual open enrollment period from October 15 to December 7.