Insulin Coverage: What Medicare Beneficiaries Need To Know For 2025

Since January 1, 2023, there has been a cap on insulin for Medicare beneficiaries.

• The cap applies to those who have Part D prescription drug coverage, whether through a stand-alone plan or as part of a Medicare Advantage plan. (The cap also applies to insulin administered via a pump under Part B, medical insurance.)
• P art D enrollees will pay no more than $35 for “an insulin that is included in the on a Part D sponsor’s formulary.”
• The plan’s deductible does not apply.
• The cost is the same at preferred or standard pharmacies
• Part D plans can add or remove medications from their plan during the year.

It is the last bullet point that’s creating issues. During the 2023 Open Enrollment Period, I discovered that some clients’ insulin would not be covered by their plans in the new year. A quick check of the 2024 plans discovered: