Does Medicare Cover Insulin? Costs and the $35 Cap in 2026

The $35 monthly insulin cap, explained

Medicare limits what you pay for insulin to no more than $35 for a one-month supply of each covered insulin product. This cap applies under both Part D (prescription drug coverage) and Part B (for insulin used with certain pumps).

You do not have to meet a deductible before the cap kicks in. The deductible does not apply to covered insulin, so you pay no more than $35 per month from the very start of the year.

Under Part D, the $35 limit holds across every coverage phase — including the deductible phase and the coverage gap. In short, no matter where you are in your plan year, a covered insulin product should never cost you more than $35 for a month's supply.

The cap applies to each covered insulin product you take. If you take two different covered insulins, each is capped at $35 per month.

• No more than $35 per month for each covered insulin product
• No deductible — the $35 applies before and after any deductible is met
• Applies in every Part D phase, including the coverage gap
• Applies whether the insulin is covered under Part D or Part B

Is insulin covered under Part B or Part D?

Which part of Medicare covers your insulin depends on how you take it.

Most insulin is covered under Part D. That includes insulin you take by injection (vial and syringe), with an insulin pen, or with a disposable insulin pump. To get the $35 Part D cap, you must be enrolled in a Medicare Part D drug plan or a Medicare Advantage plan that includes drug coverage.

Insulin used with a durable (non-disposable, reusable) insulin pump is covered under Part B instead, as part of the durable medical equipment (DME) benefit. Part D does not cover insulin used with a durable insulin pump. Even under Part B, the $35 monthly cap still applies to that insulin, and the Part B deductible does not apply to it.

• Part D: insulin by injection, pen, or disposable pump
• Part B: insulin used with a durable (reusable) insulin pump (DME)
• Either way, your insulin is capped at $35 per month with no deductible
• You need a Part D or Medicare Advantage drug plan to get the Part D cap

How insulin pumps change the cost

The $35 cap covers the insulin itself, but the pump device is a separate cost when you use a durable pump.

A durable (reusable) insulin pump is durable medical equipment under Part B. For the pump device itself, you generally pay 20% of the Medicare-approved amount after you meet the Part B deductible, which is $283 in 2026. This 20% coinsurance applies to the equipment — not to the insulin, which stays capped at $35 per month.

A disposable insulin pump works differently. The insulin used with a disposable pump is covered under Part D, so it falls under the Part D side of the $35 cap.

Anyone using the Part B insulin or pump benefit also pays the standard Part B premium, which is $202.90 per month in 2026.

• Durable pump device: 20% coinsurance after the $283 Part B deductible (2026)
• Insulin for a durable pump: capped at $35/month, no deductible (Part B)
• Insulin for a disposable pump: capped at $35/month (Part D)
• Standard Part B premium in 2026: $202.90/month

What about syringes, needles, and test strips?

Insulin and the supplies you use to inject it are covered differently from blood-sugar testing supplies.

Part D covers certain supplies for injecting insulin — syringes, needles, alcohol swabs, gauze, and insulin pens and pen supplies that aren't covered under Part B. If you have only Part B and no Part D, these injection supplies are not covered, so you would pay 100% of their cost.

Test strips, lancets, and needle disposal systems are not part of the Part D insulin-supply benefit. Blood-sugar test strips and lancets are instead covered under Part B as diabetes supplies. So your testing supplies and your injection supplies can come from two different parts of Medicare.

• Part D covers: syringes, needles, alcohol swabs, gauze, insulin pens/pen supplies
• Without Part D, you pay 100% for injection supplies
• Test strips and lancets are covered under Part B (not the Part D insulin benefit)

Extra Help, the out-of-pocket cap, and 2026 changes

The $35 Part D insulin limit applies to everyone who takes insulin — including people who get Extra Help (the low-income subsidy) and people with Partial Extra Help. If you qualify for Extra Help, your costs may be even lower, but no one pays more than $35 per month for a covered insulin product.

Part D out-of-pocket spending is also capped. In 2026, your total out-of-pocket drug costs — including any insulin spending — cannot exceed $2,100 for the year. Once you reach that cap, you pay nothing more for covered Part D drugs for the rest of the year.

For 2026, the insulin cost-sharing amount for a one-month supply is technically the lesser of three amounts: $35, 25% of the maximum fair price (for an insulin selected under the Medicare Drug Price Negotiation Program), or 25% of the plan's negotiated price. Because $35 is part of that comparison, you never pay more than $35 per covered insulin per month — and you may pay less.

Plans differ in which insulin products they cover and at what negotiated price, so always confirm your specific insulin is on your plan's drug list (formulary). Medicare and its plans are run through private insurers and the federal program; this guide is independent and not affiliated with the government.

• $35 cap applies to everyone, including Extra Help and Partial Extra Help recipients
• 2026 Part D out-of-pocket cap: $2,100 for the year
• 2026 formula: the lesser of $35, 25% of the maximum fair price, or 25% of the negotiated price — so never above $35
• Confirm your insulin is on your plan's formulary; coverage and prices vary by plan