Insulin Cap Set at $35 for Young Adults (26 and Under) on Private Health Plans Starting 2026

The “Making Insulin Affordable for All Children Act” isn't just about kids; it’s making a major move to protect young adults, too. Specifically, Section 2 of this bill targets the financial stress of insulin dependency for people aged 26 and under who are covered by private health insurance. Starting with plan years on or after January 1, 2026, these plans must cap what this group pays out-of-pocket for certain insulin products.

The $35 Lifeline: No Deductible, Hard Cap

For anyone 26 or younger relying on insulin, this is a big deal. The bill mandates that for a 30-day supply of “selected insulin products,” the maximum cost-sharing (that’s your copay or coinsurance) can be no more than the lesser of $35 or 25% of the plan’s negotiated price after discounts. Even better, your plan cannot apply any deductible to these specific insulin products. Think of it this way: if you’re a 24-year-old managing Type 1 diabetes and your plan currently requires you to hit a $2,000 deductible before they cover anything, this bill means you skip that deductible entirely for your insulin and pay at most $35 a month. This applies whether you get coverage through your parents’ plan, your employer, or the individual marketplace, including those on catastrophic plans.

Who Picks the Insulin?

Here’s where the fine print matters. The insurance plan or issuer gets to decide which drugs qualify as “selected insulin products.” However, the bill forces them to cover their bases: they must pick at least one product from every different type and dosage form of insulin available. This means they can’t just pick the cheapest, least-used version; they have to provide choices that cover the range of medical needs. The cost-sharing payments you make under this new cap are required to count toward your overall annual deductible and out-of-pocket maximum, which is key for financial planning. Once you hit that maximum, your insulin is essentially free for the rest of the year.

The Trade-Off for Insurers

While this is a huge win for insulin users and their families, it’s worth noting the financial shift. Insurance companies and group health plans will absorb the difference between the actual negotiated cost of the insulin and the capped amount the patient pays. The bill explicitly states this change won't affect how the plan’s overall “actuarial value” is calculated, meaning the cost is spread across the plan’s structure. For consumers, this is a direct benefit through lower costs and increased predictability. For the plans, it means they are footing a larger portion of the bill upfront for this specific population segment, which could influence future premium adjustments, though that remains to be seen.