New $35 Insulin Cost Cap Applies to More Medicare Enrollees

By Allison Bell

News July 03, 2023 at 02:04 PM

Share & Print

The new federal cost-sharing limits for Medicare enrollees who use insulin could now help more of your clients.

The Inflation Reduction Act of 2022 imposed a $35-per-month cap on how much clients with Medicare Part D prescription drug coverage pay for their insulin starting Jan. 1.

Some clients with diabetes may get insulin through pumps purchased through Medicare Advantage plans or through the "Original Medicare" Part B outpatient hospital services and physician services plan. For them, the $35 cap took effect on July 1.

What It Means

Some clients with diabetes may now spend less on insulin.

Medicare Supplement Insurance

Some clients might use Original Medicare together with Medicare supplement insurance.

The Centers for Medicare and Medicaid Services, the agency that oversees Medicare, notes that the Medicare Part B deductible does not apply to spending on insulin.

Medicare Part B enrollees without Medicare supplement insurance could pay up to $35 in coinsurance per month for insulin.

But CMS says that any Medicare supplement insurance policies that pay Medicare Part B coinsurance amounts should pay a client's monthly insulin coinsurance bills.