The $35 insulin cap is one of the most valuable Medicare changes for seniors with diabetes. Here is exactly how it works in 2026.
What is the Medicare $35 insulin cap?
The $35 insulin cap, created by the Inflation Reduction Act, limits your cost-sharing for a one-month supply of each covered insulin to $35 or less, with no deductible applied to insulin. It continues in full force in 2026. For 2026, the cap is calculated as the lesser of $35, 25% of the maximum fair price for a negotiated product, or 25% of the negotiated price, so your cost could be even below $35. The cap applies to all Part D enrollees, including those with Extra Help. Call 1-800-MEDIGAP to confirm it applies to your insulin.
Does the cap apply to insulin pumps and every coverage phase?
Yes on both counts. The $35 cap holds in every Part D coverage phase, so you never pay more than $35 for a one-month supply of each covered insulin, even before meeting your deductible. It also extends to insulin used in insulin pumps, which is covered under Part B. Part B uses coinsurance instead of a copay, but in 2026 that coinsurance for insulin cannot exceed $35 per month. Whether your insulin is billed under Part D or Part B, your monthly cost is protected. A free check at 1-800-MEDIGAP confirms your coverage.