Diabetes affects more than 38 million Americans, according to the Centers for Disease Control and Prevention, and managing it requires ongoing medications, supplies, lab tests, and doctor visits. The American Diabetes Association has estimated that people diagnosed with diabetes have medical expenses more than twice as high as people without it. Understanding how coverage works for each part of your care can help you manage diabetes costs with insurance and avoid paying more than necessary.
Insulin: caps and price changes
Medicare
Since 2023, the Inflation Reduction Act has limited cost-sharing for each covered insulin product to $35 for a month’s supply for people with Medicare Part D or Medicare Advantage drug coverage, with no deductible. Insulin used with a traditional pump, which is covered under Part B as durable medical equipment, also has a $35 monthly cap and no Part B deductible.
Private insurance and the uninsured
There is no federal cap on insulin costs for private insurance, but many states have passed laws limiting copays for state-regulated plans, often to $35 or a similar amount per month. These laws usually do not apply to self-funded employer plans regulated by federal ERISA rules, so check what kind of plan you have.
In 2023, the three largest insulin manufacturers announced significant list price reductions for many of their older insulin products and expanded programs capping out-of-pocket costs at $35 per month for many commercially insured and uninsured patients. Program terms change, so check each manufacturer’s current offer for your specific insulin. Some retailers also sell lower-cost human insulin over the counter, but switching insulin types should always be done with medical guidance because dosing and timing differ.
Continuous glucose monitors
Continuous glucose monitors (CGMs) measure glucose levels through a small sensor worn on the skin and send readings to a receiver or phone. They can reduce the need for fingersticks and help with insulin adjustments.
Medicare coverage
Medicare Part B covers therapeutic CGMs as durable medical equipment for people with diabetes who use insulin or who have a history of problematic hypoglycemia, under coverage criteria revised in 2023. You typically pay 20 percent coinsurance after the Part B deductible, and supplies must come from a Medicare-enrolled supplier or, for some systems, a pharmacy.
Private insurance
Many commercial plans cover CGMs under either the medical benefit, as durable medical equipment, or the pharmacy benefit. Coverage under the pharmacy benefit often means a predictable copay; under the DME benefit, you may pay coinsurance after the deductible. Plans may require documentation of insulin use, frequent testing, or hypoglycemia. If denied, ask your doctor to submit a letter of medical necessity and appeal.
Over-the-counter CGMs
Since 2024, some CGMs have been cleared by the FDA for over-the-counter purchase, aimed at adults not using insulin. These are usually paid out of pocket, but you may be able to use HSA or FSA funds.
Insulin pumps
Insulin pumps, including automated insulin delivery systems that connect to a CGM, are covered by Medicare and most private plans when medical criteria are met. Traditional tubed pumps are often covered as durable medical equipment. Some patch pumps are covered under the pharmacy benefit for Part D plans or commercial plans. Pumps are expensive, and supplies such as infusion sets and reservoirs are ongoing costs. Check whether your plan requires a specific brand or supplier.
Testing supplies
Blood glucose meters, test strips, and lancets are covered by Medicare Part B, with limits on quantities based on whether you use insulin, which your doctor can exceed with documentation. Commercial plans often have preferred brands. Using a preferred meter can lower costs substantially.
Newer medications: GLP-1s and SGLT2 inhibitors
Medications such as GLP-1 receptor agonists and SGLT2 inhibitors are widely prescribed for type 2 diabetes and can also benefit heart and kidney health. They are brand-name drugs with high list prices. Medicare Part D and most commercial plans cover them for diabetes, often with prior authorization and step therapy requirements, such as trying metformin first. Under the Part D redesign, annual out-of-pocket costs for covered drugs are capped ($2,100 in 2026), which helps beneficiaries taking several brand-name medications. Medicare’s negotiated prices for several diabetes drugs, including some SGLT2 inhibitors and insulins, took effect in 2026.
Manufacturer savings cards can lower copays for commercially insured patients but cannot be used with Medicare or Medicaid. Some plans use copay accumulator programs, which do not count manufacturer assistance toward your deductible, so check how your plan treats these cards.
Preventive services and screenings
Under the Affordable Care Act, most plans must cover certain preventive services without cost-sharing, including screening for type 2 diabetes in certain adults at higher risk. Medicare covers diabetes screening for at-risk beneficiaries and the Medicare Diabetes Prevention Program for people with prediabetes. Once diagnosed, routine services such as A1C tests, eye exams, foot exams, and kidney function tests are typically covered, though cost-sharing may apply. Medicare covers diabetes self-management training and medical nutrition therapy, and some commercial plans do as well.
Some high-deductible health plans now cover certain chronic disease medications, including insulin and glucose meters, before the deductible, under IRS rules allowing preventive care treatment for chronic conditions. Ask your plan.
Assistance programs
- Manufacturer patient assistance programs offer free or low-cost medications for uninsured or underinsured people meeting income criteria.
- Medicaid covers diabetes medications and supplies, often with minimal copays.
- Extra Help reduces Part D drug costs for people with limited income.
- Community health centers offer sliding-scale fees and may have access to discounted drugs through the federal 340B program.
- State pharmaceutical assistance programs exist in some states for older adults.
- Nonprofit organizations such as the American Diabetes Association provide information on affordable insulin options.
Practical tips to reduce costs
- Review your plan’s formulary each year and ask your doctor about covered alternatives.
- Use 90-day supplies through mail order where your plan offers lower costs.
- Ask about preferred brands for meters, CGMs, and insulin.
- Track your deductible and out-of-pocket maximum, and plan expensive purchases, such as a pump, in a year when you have already met your deductible.
- Use HSA or FSA funds for copays and supplies.
- Do not ration insulin. If you cannot afford it, contact your doctor, pharmacist, or manufacturer immediately. Rationing can lead to diabetic ketoacidosis, which is life-threatening.
Workplace and legal protections
The Americans with Disabilities Act generally protects people with diabetes from employment discrimination and can require reasonable accommodations, such as breaks to check glucose or eat. Health insurers in the individual and employer markets cannot deny coverage or charge more based on diabetes as a pre-existing condition under the ACA.
Budgeting for the full year
A useful exercise is to list every recurring diabetes expense and estimate its annual cost under your plan: insulin or oral medications, CGM sensors, pump supplies, test strips, specialist visits, lab work, and eye exams. Then compare that total with your plan’s deductible and out-of-pocket maximum. Many people with diabetes on insulin reach their out-of-pocket limit each year. In that case, a plan with a higher premium but lower out-of-pocket maximum may cost less overall, while a lower premium plan may be better for people whose diabetes is managed with inexpensive generics. During open enrollment, run this comparison for each available plan rather than defaulting to last year’s choice.
Related reading: Medicaid Eligibility in 2026: Income Limits, Expansion States, and How to Apply.
Frequently Asked Questions
Does the $35 insulin cap apply to my employer plan?
Not automatically. The federal cap applies to Medicare. Your employer plan may be subject to a state cap if it is fully insured, or may voluntarily offer low copays.
Will Medicare pay for a CGM if I take only oral medications?
Medicare generally covers CGMs for insulin users or people with problematic hypoglycemia. Check current criteria with your doctor.
Can I use an HSA for diabetes supplies?
Yes. Insulin, testing supplies, CGMs, and pumps are qualified medical expenses.
This article is for general informational purposes only and is not legal, medical, tax, or financial advice. Rules vary by state and change over time; confirm details with the relevant agency or a licensed professional.
