How much does insulin cost in 2027 depends on your plan type: state caps, deductibles, formularies and uncovered diabetes supplies all move the number. A KFF Health News report published November 13, 2026 focused on North Dakota’s new $25 monthly insulin cap and the limits on who receives its protection. The key point for plan shoppers is that a cap is not a universal price guarantee. The plan type, deductible, covered products and diabetes supplies all affect the final cost.
How much does insulin cost under different types of coverage?
There is no single 2027 insulin price that applies to every insured person. The American Diabetes Association lists 29 states plus the District of Columbia with caps in state-regulated commercial plans. State rules generally apply to individual and small-group insurance regulated by the state. They generally do not reach self-funded employer plans governed by federal ERISA rules.
| State | Sample cap |
|---|---|
| New York | $0 per 30-day supply |
| North Dakota | $25 per 30-day supply |
| Texas | $25 per 30-day supply |
| Massachusetts | $25 per 30-day supply |
| New Mexico | $25 per 30-day supply |
| Minnesota | $25 medications; $50 supplies monthly |
| Maryland | $30 per 30-day supply |
| Oklahoma | $30 per 30-day supply |
| California | $35 per 30-day supply |
| Illinois | $35 per 30-day supply |
| Montana | $35 per 30-day supply |
| Oregon | $35 per 30-day supply |
| Washington | $35 per 30-day supply |
| Rhode Island | $40 per 30-day supply |
| Louisiana | $75 per 30-day supply |
This is a sample, not a complete state-by-state list. The American Diabetes Association’s state cap listing describes state-regulated commercial coverage. A state cap does not cover every insured person, and the cap’s scope can differ by state, plan and product.
Individual and small-group plans: State-regulated plans may be subject to a state insulin copay cap. The plan must cover the particular insulin for the cap to be relevant.
Self-funded employer plans: These plans are typically regulated under federal ERISA rules, not state insurance laws. State insulin copay caps generally do not apply. The HHS Office of the Assistant Secretary for Planning and Evaluation reports that self-funded plans covered 63 percent of workers with employer coverage in 2024. Ask HR whether an employer plan is self-funded; the insurer’s name on an insurance card does not answer that question.
Medicare: Medicare’s statutory cap is no more than $35 for a one-month supply of each covered insulin product, with no deductible for insulin. Medicare.gov says a covered three-month supply generally costs no more than $105. Coverage details vary by Part B or Part D, and insulin-related supplies do not all receive the same treatment.
Medicaid: Medicaid cost sharing for covered insulin is generally nominal. Exact coverage and cost-sharing details depend on the state program and the person’s eligibility.
The deductible exception can change the North Dakota cap
North Dakota’s 2025 HB 1114 sets a $25 limit for a 30-day supply of covered insulin and a separate $25 limit for certain covered insulin dosing and administration supplies under state-regulated plans. But the bill’s statutory language includes an exception for an HSA-qualified high-deductible health plan (HDHP): the cap does not apply to the plan deductible until the enrollee meets the federal minimum deductible.
In practical terms, a person enrolled in a qualifying HDHP could face the plan’s negotiated or otherwise applicable price at the pharmacy counter in January, before meeting that deductible. The $25 cap may apply after the required deductible threshold. The exact amount charged depends on the plan’s terms and the covered product. ASPE reports that 33 percent of covered workers were enrolled in an HDHP with a savings option in 2025.
A cap can therefore provide different protection in two plans issued in the same state. A non-HDHP plan may apply the cap even while other medical costs remain subject to a deductible. An HSA-qualified HDHP may have to apply the insulin cap only after the specified deductible threshold. Confirm the plan’s written terms before enrolling.
What an insulin cap does not cover
The North Dakota law excludes insulin pumps, electronic insulin-administering smart pens, continuous glucose monitors (CGMs), and supplies needed specifically for those devices. Its separate supply cap covers listed basics such as meters, test strips, lancets, ketone testing supplies, glucagon, pen needles and syringes.
That distinction matters because insulin is one line in a diabetes budget. Sensors, pump supplies, test strips and glucagon can add costs, and the state cap does not necessarily limit those device-related expenses. KFF Health News reported that the Kritzberger family, despite having insurance, spends at least $8,000 a year on drugs, supplies and appointments for their daughter Nina, who has type 1 diabetes. The report illustrates why a cap on the drug does not establish a ceiling for total diabetes care.
Example: A Fargo Marketplace shopper comparing bronze and silver
Consider a 41-year-old Fargo resident with type 2 diabetes who uses two insulins and is comparing a bronze HDHP with a silver ACA marketplace plan for 2027. No specific plan deductible, premium or formulary is assumed here.
If the bronze option is an HSA-qualified HDHP, North Dakota’s deductible exception may mean she pays the applicable plan cost for covered insulin until she reaches the federal minimum deductible. After that point, the state’s $25 monthly insulin cap may apply to covered insulin under the law. The cap does not mean that each of her two insulin prescriptions will necessarily cost $25; HB 1114 sets a limit per pharmacy or distributor, regardless of the quantity or type used to fill covered prescription needs.
If the silver plan is not an HSA-qualified HDHP, the state cap may apply without waiting for that deductible threshold, assuming the plan is state-regulated and covers her insulin. But a higher premium could outweigh savings at the pharmacy. She should compare the annual premium plus expected deductible and copays for both insulins and supplies, as well as the out-of-pocket maximum. Do not assume the cap covers CGM costs or every diabetes supply.
A Texas employee faces a different version of the same limitation. Texas has a $25 state cap, but if his employer plan is self-funded, the state cap generally does not reach that plan. Two coworkers using the same insulin can therefore pay different amounts because their employers have different funding arrangements and plan designs.
Open enrollment deadline and plan comparison checklist
For most 2027 Marketplace coverage, open enrollment runs through January 15, 2027. Enrolling by December 15, 2026 is generally required for coverage beginning January 1. Enrolling from December 16 through January 15 generally starts coverage February 1. Confirm dates and effective coverage details for the Marketplace and plan being considered.
Before selecting coverage, check these five items:
- Get the plan’s drug list and confirm each insulin and relevant supply by name and formulary tier.
- Confirm whether each insulin and diabetes supply is covered before the deductible.
- Calculate the annual deductible plus expected copays or coinsurance for a 12-month supply. Include premiums separately.
- Ask HR whether an employer plan is self-funded or fully insured. The insurer may administer either type.
- Confirm whether the state has an insulin copay cap and whether the law covers supplies as well as insulin.
Three questions for a licensed agent:
- Is this plan state-regulated or self-funded, and does the applicable insulin cap reach it?
- Are my specific insulins covered before the deductible, and at what tier?
- Which diabetes supplies, including my CGM or pump supplies, are outside the cap?
A North Dakota consumer may find a licensed agent who can review a plan’s formulary and network; VerifiedAgent’s directory displays license status and NPN so consumers can confirm an agent’s licensing before sharing plan details.
What changes in 2027?
California’s $35 cap extends to small-group plans on January 1, 2027, according to the ADA listing. Medicare’s $35 cap is already in force for covered insulin, subject to Medicare’s stated rules. KFF Health News reported that a federal bill to cap monthly insulin costs at $35 had 28 bipartisan Senate co-sponsors as of November 13, 2026. Its status may change; passage should not be assumed.
A copay cap is not a premium cap. As reported by KFF Health News, insurers and the North Dakota state chamber argued that coverage mandates could increase premiums. That debate reflects a basic distinction: a cap limits certain patient cost sharing at the pharmacy, while premiums and other plan costs are determined separately. Because state caps generally do not reach self-funded ERISA plans, the same state and the same insulin can still produce different bills for different workers.
For 2027, the most reliable way to answer how much insulin will cost is a plan-specific calculation: verify coverage and tier, determine when the deductible applies, identify any state or federal cap, and account separately for devices and supplies. Available plan documents should be reviewed before enrollment. Current rules, covered products and costs may differ, so details should be independently confirmed with the plan.