You should tell Mr. McCarthy that, yes, his insulin costs can be covered under the MA‑PD plan you represent, but that coverage depends on two key conditions that you must verify:

  1. the insulin he uses is on the plan’s formulary, and
  2. he uses the appropriate benefit (Part D or, in some cases, Part B) for how the insulin is administered.

What you should say (compliance‑appropriate)

You could respond along these lines:

“Medicare Advantage plans that include Part D drug coverage, like the one I represent, generally cover many types of insulin, as long as they are on the plan’s drug list, called a formulary. Your insulin will be subject to the same Medicare insulin cost protections as other Part D plans, which cap out‑of‑pocket costs for covered insulin products each month. To be sure, I’ll check whether your specific insulin and dose are on this plan’s formulary and what your copayment would be.”

This style of answer does three important things:

  • Confirms that insulin is generally covered under MA‑PD plans.
  • References the monthly cap on insulin costs under Medicare drug coverage (without promising a specific dollar amount until you check the plan’s document).
  • Makes clear that final coverage depends on the plan’s formulary and benefit details.

Key points to include when explaining

When you walk him through coverage, you should:

  • Clarify that:
    • Insulin used with syringes or pens is typically covered under the plan’s Part D (drug) benefit, subject to the plan’s formulary and copays.
    • Insulin used in a pump may be covered under the medical (Part B) side of the MA‑PD, rather than Part D.
  • Mention that Medicare rules currently limit how much a beneficiary pays each month for covered insulin under Part D‑type coverage, but the exact copay or coinsurance amount depends on:
    • Whether the product is on the formulary.
    • The tier on which it is placed.
    • The pharmacy type (preferred vs. standard vs. mail order), if that matters for your plan.

You should not promise coverage for “all insulin” or quote an exact copay until you confirm for his specific product and pharmacy.

How to close the conversation with him

End with a clear, action‑oriented offer:

“If you can provide the name and dose of your insulin and the pharmacy you use, I can look it up on this plan’s drug list and tell you exactly what your monthly cost would be under this MA‑PD option. If it isn’t covered, we can also look at whether there is a therapeutically similar insulin that is on the formulary and discuss with your prescriber.”