The $35 is a ceiling for each covered insulin product, each month, not a flat price. A three-month supply costs no more than $105. Under Part D the limit applies to everyone who takes a covered insulin, including people who get Extra Help, and it applies the same way in a Medicare Advantage plan that includes drug coverage. From 2026 on, federal law sets the amount at the lesser of $35 or a quarter of the price negotiated for that insulin, so some insulins cost less. Covered is the key word: the limit applies to insulin on your plan’s formulary.
| How you take insulin | Paid by | Most you pay | Deductible |
|---|---|---|---|
| Pen, vial or syringe | Part D | $35 a month | Does not apply |
| Disposable patch pump, or inhaled insulin | Part D | $35 a month | Does not apply |
| Pump covered as durable medical equipment | Part B | $35 a month | Does not apply |
| Three-month supply of one insulin | Part D or Part B | $105 | Does not apply |
How the limit works
Your plan cannot charge more than $35 for a month’s supply of each covered insulin, whatever drug tier it sits on and whether or not you have met the deductible. If you use two insulins, say a long-acting and a rapid-acting one, each is limited separately, so the most you pay is $35 for each. What you pay for insulin counts toward the $2,400 Part D out-of-pocket cap for 2027, and once you reach that cap you pay nothing for covered drugs for the rest of the year. Under Part B the limit applies to insulin used with a pump Medicare covers as durable medical equipment, and a Medigap policy that pays your Part B coinsurance should pay that share.
What the limit leaves out
Supplies are the usual surprise. Under Part B you pay the full cost of syringes, needles, alcohol swabs and gauze, and they are not part of the $35 limit; a Part D plan may cover some of them. Your plan also decides which insulin products are on its formulary for 2027. If an insulin you use is not on that list, the limit does not apply to it, so a formulary change in your Annual Notice of Change is worth reading line by line.
What to do next
Before December 7, check that each insulin you use is on the 2027 formulary of the plan you are choosing, and price it as a 90-day fill as well as a 30-day fill. The $105 three-month ceiling only helps if your plan and pharmacy offer the longer supply. If you use a pump, ask whether it is covered under Part B as medical equipment or under your drug plan, because that decides which part of Medicare pays for the insulin in it.
Read the full guide: How Medicare Part D works
Related questions
Does the $35 insulin limit apply if I get Extra Help?
Yes. Under Part D the $35 limit applies to everyone who takes a covered insulin, including people who get Extra Help.
Does the Part D deductible apply to insulin?
No. You do not pay a deductible for covered insulin under Part D or Part B, so the $35 limit applies from your first fill of the year.
Is the $35 limit still in place in 2027?
Yes. Federal law sets it for plan year 2026 and every plan year after, so it is not a one-year program and needs no renewal for 2027.
Sources
- Insulin — Medicare.gov (CMS) · read 2026-10-30
- 42 U.S.C. 1395w-102(b)(9), Treatment of cost-sharing for covered insulin products — U.S. Government Publishing Office (United States Code, 2023 edition) · read 2026-10-30
- Costs for Medicare drug coverage — Medicare.gov (CMS) · read 2026-10-13
This page explains published rules and figures, with the source for each one. It is not advice about your own situation.