Using Insulin, am I charged $35 (or less) if I get Partial Extra Help?

If you are enrolled in Medicare Part D and receive partial Extra Help to pay for your prescription drug costs, you may be eligible for reduced copayments for insulin. Under the Part D Senior Savings Model, participating Medicare Part D plans must offer a maximum copayment of $35 for a one-month supply of insulin, or less if the plan chooses to offer a lower copayment.

If you get Partial Extra Help with your Part D costs, you'll pay $35 (or less) for a month's supply of a covered insulin product. People with Full Extra Help already have lower cost-sharing benefits for insulin and will continue to pay the lower amounts.

To be eligible for the Part D Senior Savings Model, you must be enrolled in a Medicare Part D plan and receive partial Extra Help to pay for your prescription drug costs. You must also be using one of the insulin formularies or equipment products covered by the program, which includes a range of insulin types and brands. It's important to note that the copayment reduction only applies to insulin and does not apply to other prescription drugs or medical services. Beneficiaries should review their Medicare Part D plan carefully and work closely with their healthcare providers to understand their coverage and out-of-pocket costs for insulin and other prescription drugs.