Yes, insulin is covered by most types of health insurance in the United States, including Medicare, Medicaid, employer-sponsored plans, and marketplace plans. The more practical question is how much you’ll actually pay out of pocket, and that depends on your specific coverage. A federal cap of $35 per month now applies to all Medicare enrollees, and more than two dozen states have passed their own copay caps for private insurance.
Medicare: The $35 Monthly Cap
If you’re on Medicare, your insulin costs are now capped at $35 for a one-month supply of each covered insulin product, with no deductible. This applies to both Part B (which covers insulin used with a durable insulin pump) and Part D (which covers injectable insulin, inhaled insulin, and insulin used with disposable or patch pumps). Order a three-month supply and you’ll pay no more than $105 total. The cap applies to every Medicare enrollee who takes insulin, including those receiving Extra Help (the low-income subsidy).
Part D plans also cover related supplies like syringes, needles, gauze, and alcohol swabs. Part B, however, does not cover insulin pens or injection supplies separately. If you use a traditional durable insulin pump, your insulin and the pump itself fall under Part B’s medical equipment benefit.
Employer and Marketplace Plans
Private insurance through your employer or the ACA marketplace almost always includes insulin on its formulary, but your cost-sharing varies widely by plan. Some plans place insulin on a preferred tier with a flat copay of $30 to $50, while others put brand-name insulin on a specialty tier where you pay a percentage of the list price. Biosimilar and authorized generic insulins are available but aren’t always placed on lower tiers than brand-name products.
One important change affects people with high-deductible health plans (HDHPs) paired with health savings accounts. Normally, HDHPs require you to meet your full deductible before coverage kicks in. But starting with plan years after December 31, 2022, the IRS confirmed that HDHPs can cover insulin and insulin delivery devices before the deductible is met. This means your HDHP may treat insulin like preventive care, so check with your plan to see if it has adopted this option.
State Copay Caps for Private Insurance
More than 25 states and the District of Columbia have passed laws capping what insured residents pay for insulin each month. These caps apply to state-regulated health plans, which typically include individual and small-group policies purchased within the state. Self-funded employer plans (common at large companies) are regulated at the federal level and usually aren’t subject to state caps.
The caps range from $0 to $100 per 30-day supply, depending on where you live:
- $0: New York
- $25: Connecticut, Massachusetts, Minnesota, New Mexico, North Dakota, Texas
- $30: District of Columbia, Kentucky, Maryland, New Hampshire, Oklahoma, Utah
- $35: California (large group plans now, small group by 2027), Illinois, Maine, Montana, Nebraska, Nevada, New Jersey, Oregon, Washington
- $40: Rhode Island
- $50: Virginia
- $75: Louisiana
- $100: Alabama, Colorado, Delaware, Vermont
Some states extend their caps beyond insulin to include diabetes supplies and devices. Connecticut, for example, caps diabetes device costs at $100 per month, and Delaware eliminates cost-sharing for insulin pumps entirely. If your state isn’t on this list, your out-of-pocket cost depends entirely on your plan’s formulary and benefit design.
Manufacturer Price Cuts
Even outside insurance, the retail cost of insulin has dropped significantly. Eli Lilly cut the list prices of Humalog and Humulin by 70% in 2023 and reduced its generic lispro insulin to $25 per vial, down from $126. The company also caps copays at $35 for uninsured patients and those with private insurance who use its savings programs. Novo Nordisk and Sanofi have made similar moves, though specific pricing varies by product.
These manufacturer price reductions matter most if you’re uninsured or if your plan’s cost-sharing is based on a percentage of the list price rather than a flat copay. A 70% drop in list price translates directly into lower coinsurance payments.
Options if You’re Uninsured or Underinsured
All three major insulin manufacturers offer patient assistance programs (PAPs) that provide free or deeply discounted insulin to qualifying individuals. Novo Nordisk’s program, for example, is open to uninsured patients with household income at or below 400% of the federal poverty level (roughly $62,400 for a single person in 2024). Medicare enrollees can also qualify, though income thresholds and documentation requirements differ.
Applying typically requires proof of income, and if you might be eligible for Medicaid or Medicare’s Extra Help program, you’ll generally need to show a denial letter from those programs before the manufacturer will enroll you. The application process is straightforward but does involve paperwork, so expect to gather tax documents or pay stubs and possibly a government ID.
For people who need insulin urgently, some states have emergency access provisions. Minnesota, for instance, requires manufacturers to provide a 30-day emergency supply for $35 and a 90-day supply for $50 through a state-mandated assistance program. Walmart and some pharmacy chains also sell older formulations of insulin (such as ReliOn brand) over the counter for significantly less than newer analogs, though these are not direct substitutes for all prescriptions and should only be used in consultation with whoever manages your diabetes care.
How to Find Your Actual Cost
The fastest way to find out what you’ll pay is to check your plan’s formulary, which is the list of covered drugs and their tier placement. You can usually find this on your insurer’s website or by calling the number on your insurance card. When you look up your specific insulin product, you’ll see which tier it falls on and whether your plan requires prior authorization or step therapy (trying a lower-cost insulin first).
If the formulary cost is higher than you expected, ask your prescriber whether a therapeutically equivalent insulin sits on a lower tier. Switching from a brand-name rapid-acting insulin to its biosimilar or authorized generic version can sometimes cut your copay in half without changing how well it works. Your pharmacist can also run the prescription through your insurance at the counter to give you a real-time price before you commit to filling it.