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What to Know About the Medicare Insulin Cost Cap

Aging Benefits Advisory Medicare Insulin Cost Cap

The Medicare insulin cost cap is the first step in a long process of reducing out-of-pocket costs for Medicare policyholders.

As of January 1st, Medicare’s new insulin cap came into effect, making all insulin covered by Medicare cost no more than $35 per monthly dose. This is a great change that is just one step in the long process of bringing out-of-pocket costs down for Medicare policyholders. While this change is welcome for the relief it will bring to many policyholders, there are a few caveats that need to be understood and accounted for if you are a Medicare policyholder that requires insulin.

Not All Insulin is Covered

While it doesn’t matter if you have Type 1 or Type 2 diabetes, it does matter which insulin you take to manage your condition. Unfortunately, not all insulin is affected by this change—you will need to check your Medicare Part D plan to determine whether your insulin is covered under this new cap.

If your plan does not cover the insulin you currently use, there are a couple of options for you to explore. The first option is to change your current Medicare Part D plan to one that does cover the insulin you currently use. Due to the changes taking place this year, Medicare is allowing all policyholders the opportunity to make a single change to their plan by December 31st without needing to wait for the Annual Enrollment Period. The second option is to speak with your doctor about the possibility of switching to insulin that is covered by your plan.

How You Take Your Insulin Matters

While many insulin options are covered by Medicare Part D and have therefore been affected by the change that took place on January 1st, some insulin that is provided by pumps is covered through your Medicare Part B plan. While these insulin options will also be covered by the $35 cap, this doesn’t take effect until July 1st. 

It’s also important to remember that only the insulin itself is covered under this cap. Any pumps, syringes, or other medical supplies that are needed to take insulin will not be covered under this cap and could cost more than $35.

How to Get More Information

If you have questions, are in need of more information, or want to discuss your options—there are some things you can do. First, you can contact a trusted advisor such as Aging Benefits Advisory. They will be happy to help you understand how these changes affect you and what you can do to ensure that your insulin is covered under this new cap. The benefit of this option is that you can speak to someone in person without feeling rushed, so you’ll get tailored advice to help you make the most of your Medicare policy and get the best results. You can also call the Medicare hotline at 800-MEDICARE (800-633-4227), which is staffed 24/7/365. 

Contact Aging Benefits Advisory Today!

If you need help navigating the world of senior health insurance, our advisors at Aging Benefits Advisory are here to assist. Take advantage of our free consultation to ensure that you receive the plan for your budget and needs. We specialize in Medicare Advantage, Medicare Supplements, Dental, Vision, and Final Expense insurance for the senior market of Pinellas County, Pasco County, Manatee County, Hillsborough County, Polk County, Sarasota County, Citrus County, and Marion County, Florida. If you would like a free consultation, contact us online or give us a call at 727-266-0355. For more information, follow us on Facebook, Pinterest, and YouTube.

This entry was posted on Thursday, May 11th, 2023 at 4:21 pm. Responses are currently closed, but you can trackback from your own site.