Under Medicare, you pay no more than $35 for a one-month supply of each covered insulin product, whether it's covered by your Part D drug plan or by Part B through an insulin pump. Medicare.gov says a three-month supply generally costs no more than $105. Insulin supplies, like syringes, needles, and disposable patch pumps, aren't capped at $35.
Which part of Medicare covers my insulin?
Medicare.gov explains it depends on how you take it:
Part D covers:
- Insulin you inject with pens or syringes.
- Insulin used in disposable "patch" pumps.
- Inhaled insulin.
- Supplies for injections, like syringes, needles, alcohol swabs, and gauze, if you have Part D.
Part B covers:
- Insulin used with a traditional insulin pump that's covered as durable medical equipment.
Medicare.gov says Part B doesn't cover insulin you inject with pens, insulin for disposable patch pumps, or injection supplies.
How does the $35 limit work in Part D?
- You pay no more than $35 for a one-month supply of each covered insulin product.
- Medicare.gov says the $35 limit applies to everyone who takes insulin, even people with Extra Help. People with Extra Help may pay less.
- Medicare.gov says you don't have to pay a deductible for insulin. So even early in the year, you pay no more than $35 for the month's supply.
- For a three-month supply, your costs can't be more than $35 for each month's supply. That's generally no more than $105.
Insulin costs also count toward your yearly Part D out-of-pocket cap, which Medicare.gov lists at $2,100 in 2026 and $2,400 in 2027. See the Part D out-of-pocket cap.
How does the $35 limit work in Part B?
If you use a traditional insulin pump covered under Part B, Medicare.gov says your insulin costs no more than $35 for a one-month supply, with no deductible for the insulin. If you have a Medigap policy that pays Part B coinsurance, Medicare.gov says the policy should cover that amount.
The pump itself is durable medical equipment, with its own costs. In some areas, you may need to use specific pump suppliers for Medicare to cover it. See durable medical equipment bills.
What isn't capped at $35?
- Injection supplies like syringes, needles, alcohol swabs, and gauze. Part D covers them at your plan's regular cost, outside the $35 insulin cap. Medicare.gov says Part B doesn't cover them.
- Disposable patch pumps. Medicare.gov says the pump can be covered under Part D as a supply, but because it's a supply and not a drug, the cost isn't capped at $35. The insulin that goes into it is.
- Insulin your plan doesn't cover. The cap applies to covered insulin products. If yours isn't on your plan's list, see below.
What if my pharmacy charged more than $35?
Check these things first:
- Is it more than a one-month supply? A 90-day fill could be up to $105.
- Is more than one insulin product included? The cap is per product. Two different insulins could each be up to $35.
- Were supplies included? Syringes, needles, or a patch pump may be priced separately.
- Is the insulin covered by your plan? If not, the cap may not apply.
What to say to the pharmacist:
"I was charged $[amount] for [insulin name]. Medicare caps covered insulin at $35 for a one-month supply. Can you check whether this was billed to my Part D plan as covered insulin, how many days' supply it was, and whether supplies were included?"
What to say to your plan:
"I paid $[amount] for a [30/90]-day supply of [insulin name] on [date]. Is this insulin covered under my plan? If so, why wasn't it limited to $35 a month? Can you fix the claim and refund the difference?"