Medicare Part D coverage of insulin supplies
For individuals on insulin therapy--whether through injection, inhalation, or the use of an insulin pump--beneficiaries should be aware Medicare coverage may be limited depending on which type of insulin is used.
"Insulin and other insulin supplies are not covered by original Medicare alone unless the insulin is [administered] through an external pump," said Dr. Ami Sen, a medical director for WellPoint health insurance company's senior division. "The member would pay 100 percent for insulin, syringes, needles, insulin pens, alcohol swabs and gauze."
Although not a part of original Medicare, coverage for insulin and related supplies may be available through Medicare Part D plans.
Medicare Part D and insulin
While Medicare Part A and Medicare Part B provide hospital and medical insurance, they do not provide prescription drug coverage. For that, beneficiaries must enroll in Medicare Part D. These plans are available as either stand alone policies or rolled into a Medicare Advantage plan.
For insulin that is inhaled or injected, Medicare Part D covers the following supplies in addition to the insulin itself:
- Alcohol swabs
- Inhaled insulin devices
"The Part D part of a Medicare Advantage with a Prescription Drug Plan covers insulin and other diabetic medications," said Sen. "The member's cost share depends on the formulary."
A formulary is the list of all medications approved for use under the plan. According to the New York Department of Health, there is no standard formulary for Medicare Part D plans. While they must meet basic standards set forth by the federal government, each plan is free to set its own management regulations and fee structure within those guidelines.
Selecting the right Medicare plan for insulin coverage
Medicare Part D plans are offered by private health insurance companies, and benefits and costs may vary significantly between plans. Andrea Gary from the Florida State Health Insurance Assistance Program, known as SHINE, advises beneficiaries to carefully review their out-of-pocket costs as well as any limitations on their benefits.
"The beneficiary would be responsible for any coinsurance or copayment as well as the any applicable Part D deductible," said Gary.
Before signing up for a specific plan, patients should check to see if the policy limits the number of needles or syringes that will be covered each month. In addition, some Medicare Part D plans may impose restrictions on which pharmacies a beneficiary can use or require prior authorization or step therapy before paying for certain medications.
"To save money on drugs, insulin-dependent diabetics should consider purchasing a prescription drug plan along with their Medicare coverage," said Sen. "They can compare the plans available in their area on Medicare.gov to check the different drug lists and member cost shares."
Interview with Andrea Gary | SHINE, Interview with Ami Sen | WellPoint, Medicare.gov http://www.medicare.gov/publications/pubs/pdf/11022.pdf