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Does Medicare cover Insulin For Diabetics

Does Medicare Cover Insulin Pumps For Type 2 Diabetes?

Insulin pumps are small, computerized devices that help deliver insulin. They deliver it through a small tube, called a catheter, placed under the user’s skin.  

Many people with diabetes can benefit from these devices. However, insulin pumps are expensive, and not everyone who needs them can easily afford one.  

So a common question many people have is, “Does Medicare cover Insulin Pumps for Type 2 Diabetes?” In this article, we answer that question in clear, plain English. You will also find the average costs of insulin pumps and other helpful info. 

Does Medicare Cover Insulin Pumps For Type 2 Diabetes? 

The short answer is yes; Medicare will cover the cost of insulin pumps. But not 100% of the time. As is often the case with Medicare, certain conditions must be met for Medicare to pay for your insulin pumps. Below we look at what these are so you know what to expect. 

Original Medicare (Medicare Part A and Part B) provides coverage for insulin pump costs.  

There are two types of insulin pumps. They are tubed and tubeless insulin pumps. Medicare’s coverage for insulin pumps will depend on what type you get.  

But before Medicare provides coverage for your insulin pumps, you will need a prescription from your doctor and meet some requirements. Those requirements are that you: 

  • Use the insulin pump to control your diabetes 
  • Require frequent adjustments and dosages to your insulin routine 
  • Need to check your blood sugar levels at least four times a day 

Medicare Part B provides coverage for insulin pumps. It considers them to be Durable Medical Equipment (DME for short). And Medicare Part B will cover DME. 

Along with the insulin pump, Medicare Part B also provides coverage for the insulin that the pump uses.  

Medicare Part B covers 80 percent of the costs of tubed insulin pumps. You will pay for the remaining 20 percent.  

Tubeless insulin pumps are much newer than their tubed counterparts. To use a tubeless insulin pump, you wear a patch that contains several hundred units of insulin. The patch usually works with a smart device to monitor blood sugar levels and deliver insulin.  

Part D 

Some Medicare Part D plans provide coverage for tubeless insulin pumps. They do not, however, cover tubed insulin pumps. To find out if your Medicare Part D plan covers tubeless insulin pumps, contact your plan provider.  

Medicare Advantage 

Medicare Advantage plans (Medicare Part C) also provide coverage for insulin pumps. They cover everything Original Medicare covers as well as offer some additional benefits. However, coverage and out-of-pocket costs will vary depending on the specifics of your plan.  

Some Medicare Part C plans that have Part D coverage may cover tubeless insulin pumps. However, coverage for tubeless insulin pumps will vary from plan to plan.  

How Much Does Insulin Pumps Cost? 

Insulin pumps typically cost $6,000 for those without insurance. The price range runs from around $4,500 to $6,500. 

You will also pay for another $3,000 to $6,000 per year for ongoing supplies such as batteries and sensors.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series including: Does Medicare cover eyeglasses?


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