You should inform Mr. McCarthy that if he enrolls in the MA-PD (Medicare Advantage Prescription Drug) plan you represent, his insulin costs will be covered with a maximum out-of-pocket cost of $35 per month for each covered insulin product. This cost cap applies to all Medicare Part D plans, including MA-PD plans, starting in 2023, and there is no deductible for insulin under these plans. For a three-month supply, his total cost generally will not exceed $105
. Additionally, Medicare Part D plans cover injectable insulin that is not used with a traditional insulin pump, insulin used with disposable insulin pumps, and certain insulin-related supplies like syringes and alcohol swabs. If Mr. McCarthy uses an insulin pump that is covered as durable medical equipment under Medicare Part B, the insulin used with that pump may be covered under Part B, but this is less common and depends on the pump type
. In summary, under the MA-PD plan, Mr. McCarthy will have coverage for his insulin with a cost-sharing cap of $35 per month per insulin type, ensuring predictable and affordable insulin costs.
