Does Medicare Cover Insulin?
*Medicare Part D (prescription drug coverage) does not cover anything that is over and above what Medicare Part B pays for. Therefore, Medicare Part D does not cover any injectable prescription drugs such as insulin.
*Medicare Part D pays for some oral diabetes medications and supplies (diabetes pills). If you choose Medicare Part D, you must sign up for a Part D drug plan to get coverage for oral diabetes medications and supplies.
*If you are already in the Medicare Part B drug program, your Part D medications and supplies are covered under the Part B prescription drug benefit.
*Medicare Part D prescription drug plans do not have a drug formulary or a formulary of covered drugs. The Part D prescription drug plans have a formulary of covered diabetes medications and supplies. Medicare Part D plans are not required to cover all the oral medications on the formulary. They are only required to cover at least one of each type of diabetes medication and diabetes supplies.
*Medicare State Health Insurance Assistance Program (SHIP) Counselors can help you figure out if Medicare Part B or Medicare Part D is the best plan for you. SHIP counselors can also help you choose a Medicare Part D plan that will best meet your needs.
*For more information, please call the Social Security Administration at 1-877-690-1012 or your State Health Insurance Assistance Program at 1-877-690-1012.
*Source: United States Department of Health and Human Services*
Q: How can a person find out what plans are available in his/her area/state?
*You can contact your State Health Insurance Assistance Program (SHIP) to obtain a list of the Medicare prescription drug plans available in your area/state.
*SHIP counselors can also help you evaluate the prescription drug plans available in your area/state.
Website of the State Health Insurance Assistance Program (SHIP)
A: PLEASE NOTE...Your health coverage and the cost of your medicines are not affected by this information.
A: The Social Security Administration (SSA) estimates that about 6.9 million people will enroll in a Medicare prescription drug plan during the initial enrollment period. Further, the SSA estimates that about 4.8 million people will enroll in a Medicare prescription drug plan during the annual enrollment period.
Q: Are there any exceptions to the out-of-pocket maximum?
*Yes. If you participate in the Medicare Advantage Plan and your prescription drugs are covered by your Medicare Advantage Plan then there is no out-of-pocket maximum.
*You will need to contact your Medicare Advantage Plan provider to find out the details of coverage.
*If you are an outpatient hospital services patient and you are admitted to the hospital, Medicare will pick up the cost of your medications until you are discharged from the hospital.
Website of the Medicare Rights Center
Website of the Social Security Administration
Q: What are the types of Medicare prescription drug plans that are available?
*Medicare Prescription Drug Plans (PDP)
*Medicare Advantage Prescription Drug Plans
*Advantage-type Prescription Drug Plans
A: (1) Medicare Prescription Drug Plans
* These are the most popular type of Medicare prescription drug plan. These plans are offered by over 150 private health insurance companies. These plans are offered in all 50 states.
* These plans must:
- Be offered by private insurance companies.
- Provide coverage for all of the drugs on the Medicare Prescription Drug Plan formulary.
- Provide coverage for all Medicare-covered services, including doctor, inpatient hospital, and outpatient hospital care.
- Provide a grievance and appeals process.
* These plans are required to offer four different types of prescription drug coverage.
o Part D Standard coverage:
- The PDP sponsor pays 80% of the cost of your prescription drugs.
- You pay the remaining 20%.
o Part D Low-Income Subsidy (LIS) coverage:
- The PDP sponsor pays 85% of the cost of your prescription drugs.
- You pay the remaining 15%.
o Part D Extra Help:
- The PDP sponsor pays 100% of the cost of your prescription drugs.
- In most cases, you pay nothing.
o Part D Coverage Gap (also called the "donut hole"):
- The PDP sponsor pays as much as they can for your prescription drugs.
- You pay the amount that the PDP sponsor cannot pay.
- You do not have to pay more than a total of $2,510 for prescription drugs in 2013.
- In 2013, the PDP sponsor will pay what is needed to get you out of the "donut hole."
- You pay for the amount that the PDP sponsor cannot pay.
(2) Medicare Advantage Prescription Drug Plans
* These plans are offered by the same private insurance companies that offer the Part D Prescription Drug Plans.
- Be offered by private insurance companies
- Provide a grievance and appeals