If you use insulin and have Medicare, you should not be paying more than $35 per month for each insulin product you take. That cap has been in effect since January 2024, and it is saving millions of seniors real money in 2026.
But not everyone is getting the savings they deserve. Some people are still paying too much because of confusion about how the cap works, which insulin products are covered, or how to file a complaint. Here is everything you need to know.
How the $35 Cap Works
The Inflation Reduction Act of 2022 put a $35 monthly cap on the cost of insulin for Medicare beneficiaries. This applies to:
- All Medicare Part D plans (the prescription drug benefit)
- Medicare Part B insulin (insulin used with durable medical equipment, like insulin pumps)
- All types of insulin that your plan covers, including pens, vials, and biosimilars
The $35 limit is per 30-day supply of each insulin product. So if you take two different types of insulin, you pay a maximum of $35 for each one, for a total of $70 per month maximum.
Before this cap, many seniors were paying $100, $200, or even $400 per month for insulin. Some were rationing their doses or skipping them entirely because they could not afford the full cost. That should no longer happen.
The Numbers So Far
The results have been significant. According to CMS data released in January 2026:
- 3.4 million Medicare beneficiaries used the insulin cap in 2025
- Average savings per person: $480 per year
- Some patients saved over $2,000 per year, especially those on multiple insulin products or high-cost biologics
- Insulin rationing among Medicare beneficiaries dropped 40% compared to pre-cap levels, based on survey data from the Kaiser Family Foundation
For people who were spending $300 or $400 per month on insulin, the cap cut their costs by 80% or more. That is grocery money. That is rent money. That is the difference between taking your medication as prescribed and cutting doses to make a vial last longer.
Do You Qualify?
You qualify for the $35 insulin cap if:
- You have Medicare Part D (a standalone drug plan or drug coverage through Medicare Advantage)
- You have Medicare Part B and use insulin with a pump or other covered equipment
- Your insulin is on your plan’s formulary (the list of covered drugs)
You do NOT need to apply or sign up. The cap is automatic. It applies at the pharmacy counter when you pick up your insulin.
Common Problems and How to Fix Them
Even though the cap is supposed to be automatic, some people run into issues. Here are the most common problems and what to do:
Problem: You were charged more than $35
This can happen if:
- Your pharmacist’s system was not updated
- Your plan coded the insulin incorrectly
- You picked up a 90-day supply (the cap is $35 per month, so a 90-day supply would be $105 maximum)
Solution: Keep your receipt. Call your Part D plan and ask them to reprocess the claim. You are owed a refund for anything over $35 per month.
Problem: Your insulin is not on your plan’s formulary
Part D plans can choose which insulin products to cover. If your specific insulin brand is not on the formulary, the $35 cap does not help you because the plan does not cover it at all.
Solution: Ask your doctor if a covered insulin would work for you. Or during the next Open Enrollment Period, switch to a plan that covers your specific insulin. Use the Medicare Plan Finder at medicare.gov to compare.
Problem: You have a Medicare Supplement (Medigap) but no Part D
Medigap plans do not include drug coverage. If you do not have a Part D plan or Medicare Advantage with drug coverage, the insulin cap does not apply to you. You are paying the full retail price.
Solution: Enroll in a Part D plan during the next enrollment period. In the meantime, check if you qualify for Extra Help (the Low-Income Subsidy) or manufacturer discount programs.
Problem: Your doctor prescribed a non-insulin diabetes drug
The $35 cap only applies to insulin products. Other diabetes medications like metformin, Ozempic, Mounjaro, or Trulicity are not covered by this cap. Some of these drugs may be covered under the Medicare drug price negotiation program or your plan’s regular formulary.
Solution: Check your plan’s formulary for coverage and costs of your specific non-insulin diabetes drugs. The $2,000 annual out-of-pocket cap on Part D spending may still help reduce your total costs.
The $35 Cap and the $2,000 Annual Limit
Here is something many people do not realize: your insulin copays count toward the $2,000 annual out-of-pocket cap on Part D spending. So if you take insulin and other expensive medications, your insulin costs help you reach that cap sooner, after which you pay nothing for covered drugs for the rest of the year.
For example: If you pay $35 per month for insulin ($420 per year) and you also take a blood pressure medication that costs $50 per month ($600 per year), your combined spending toward the annual cap is $1,020. You would only need $980 more in other drug costs before reaching the $2,000 limit.
What About People Without Medicare?
The Inflation Reduction Act’s $35 cap only applies to Medicare. However, the law’s passage prompted many insulin manufacturers to voluntarily lower their prices for everyone:
- Eli Lilly capped the out-of-pocket cost of its most popular insulins at $35 for all patients, not just Medicare
- Novo Nordisk reduced list prices on several insulin products by up to 75%
- Sanofi capped out-of-pocket costs for its Lantus insulin at $35
If you have private insurance, check with your insurer and pharmacy about your insulin costs. Prices have dropped across the board, but the exact amount depends on your plan.
If you are uninsured, contact the insulin manufacturer directly. Most have patient assistance programs that provide free or low-cost insulin to people who qualify.
How to Make Sure You Are Getting the Right Price
Step 1: Check your most recent pharmacy receipt. If you paid more than $35 for a 30-day supply of insulin covered by Medicare, something is wrong.
Step 2: Call your Part D plan. The number is on the back of your plan card. Ask them to confirm that the $35 insulin cap is applied to your account.
Step 3: Talk to your pharmacist. Ask them to check the claim processing. Sometimes a simple resubmission fixes the problem.
Step 4: If your plan will not correct the issue, file a complaint with Medicare at 1-800-MEDICARE (1-800-633-4227) or online at medicare.gov.
Step 5: Contact your State Health Insurance Assistance Program (SHIP). SHIP counselors provide free help with Medicare issues. Find your local SHIP at shiphelp.org or call 1-877-839-2675.
Looking Ahead
The insulin cap is one of the most popular provisions of the Inflation Reduction Act. It has broad support from both political parties, and there is no serious effort to repeal it. In fact, several bills in Congress would expand the $35 cap to all Americans, not just Medicare beneficiaries.
For now, if you have Medicare and use insulin, $35 per month is your maximum cost. Make sure you are getting that price. And if you know someone with diabetes who might not be aware of the cap, share this information with them. It could save them hundreds of dollars this year.
Reported by Margaret Chen with additional research from the SeniorDaily editorial team. For corrections or updates, please contact us.
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