Preventing and Managing Diabetes

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Medicare Cap For Insulin

If you have Medicare and need insulin to manage your diabetes, there's good news. The Centers for Medicare and Medicaid Services (CMS) implemented a maximum limit of $35 per month for insulin prescriptions under Medicare Part D. This means that regardless of the type or brand of insulin you need, you will only have to pay a maximum of $35 for a 30-day supply.

The $35 cap also applies if you get a two- or three-month supply of insulin. For example, if you receive a two-month supply, the maximum cost will be $70. If you receive a three-month supply, the most you will pay is $105.

To take advantage of this new cap on insulin costs, follow these steps:

  1. Contact your Medicare Part D prescription drug plan to ensure they apply the $35 monthly cap to your insulin prescriptions.
  2. Consult with your healthcare provider to discuss your insulin needs and any necessary adjustments to your prescription.
  3. Review your coverage during Medicare's Annual Enrollment Period (AEP) from October 15 to December 7 to explore better coverage options and lower costs for insulin and other healthcare needs.

Affordable access to vital medications is crucial for managing chronic conditions like diabetes. The $35 cap on monthly insulin costs is a significant step towards ensuring affordable care.

If you have questions or concerns, contact your Medicare Part D plan provider or reach out to Medicare directly at 1-800-MEDICARE (1-800-633-4227).

At Tanner, we are committed to supporting your healthcare journey towards a healthier and more affordable future.

About Medicare Part D
Medicare Part D is a prescription drug coverage program that helps with medication costs. It is offered through private insurance companies approved by Medicare. Enrollment in Part D is optional but generally advised.

Note for Medicare Part B beneficiaries
If you use a traditional insulin pump covered under Medicare Part B's durable medical equipment (DME) benefit, the $35 cap on insulin costs starts on July 1. The Part B deductible will not apply, and if you have Medicare Supplement Insurance (Medigap) that pays your Part B coinsurance, it should cover the $35 (or less) cost for insulin.

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