News from Washington came out recently that is having a huge, positive impact on Medicare beneficiaries. The government has made mandates with regard to Medicare insulin and diabetic supplies, slashing prices in big ways!
It’s estimated that one in three Medicare beneficiaries have diabetes. With the new Senior Savings Model in place, roughly 3.3 million Medicare beneficiaries will save an average of 66% each year on diabetic insulin and supplies.
Over 1,750 standalone Medicare Part D prescription drug plans and Medicare Advantage plans with prescription drug coverage are offering lower insulin costs. This is done through something known as the Part D Senior Savings Model. This applies to 2021 Part D plans and every year after that moving forward.
Does Medicare Cover Insulin?
Currently, most Medicare Part D plans typically cover insulin and diabetic supplies. However, there can be a large out-of-pocket cost associated with this medicine.
These costs can include large, yearly deductibles that are often met quickly as the medication and supplies are costly. Once the deductible is met, the price of the medication may drop, but your cost can still be substantial. You may still pay hundreds of dollars per month, even after your deductible is met. The cost of Medicare insulin has been pricey for Medicare beneficiaries for years.
Medicare Insulin Changes Under the New Part D Senior Savings Model
Imagine having a predictable copay each month for your Medicare insulin. Under the new Senior Savings Model, this is now possible. According to the Center for Medicare and Medicaid Services (CMS), the following is true for 2021:
“Part D sponsors participating in the Model will offer beneficiaries plan choices that provide broad access to multiple types of insulin, marketed by Model-participating pharmaceutical manufacturers, at a maximum $35 copay for a 30-days’ supply in the deductible, initial coverage, and coverage gap phases of the Part D benefit.”
Essentially what this means is most Medicare beneficiaries will have the option of choosing a drug plan offering this special Medicare insulin discount.
The Key to Saving With the New Part D Senior Savings Model
In order to take advantage of the new Part D Senior Savings Model for Medicare insulin, you must enroll in a plan properly. You must enroll in a drug plan which offers this new protection during open enrollment. Open enrollment occurs yearly from October 15th through December 7th. When your new Part D drug plan begins on January 1st, you’ll pay a maximum of no more than $35 out of pocket for most insulin prescribed and even some diabetic supplies.
This new Medicare rule covers a broad spectrum of insulin, such as vials and pens. It also covers many forms of Medicare insulin, like short-acting, rapid-acting, long-acting, and intermediate-acting insulins.
What Insulin Coverage Changes Should I Expect With Medicare Advantage?
Keep in mind, this new cost-saving model is not limited to just stand-alone drug plans. Do you have a Medicare Advantage Plan? If so, you will need to check on the availability of the Senior Savings Model during open enrollment.
What Insulin Coverage Changes Should I Expect With Medicare Supplement?
If you have a Medicare Supplement Plan, you have a slight advantage over those who have chosen a Medicare Advantage plan.
Part D drug plans are not tied into Medicare supplement plans like they are with Medicare Advantage Plans. When you have a Medicare Supplement, you have the freedom to choose any stand-alone Part D drug plan in your area that offers these insulin supply discounts. This is a huge advantage.
Final Thoughts on Medicare Insulin
Out-of-pocket costs for Medicare insulin can fluctuate month to month. Many people have been faced with challenges when budgeting for their drug costs. These challenges have led to seniors not being able to afford their insulin or resorting to medication rationing. Tragically, this can result in adverse health outcomes over time.
If you’re like most seniors who have experienced the rising cost of prescription drugs and Medicare insulin, this new Senior Savings Model will come as a breath of fresh air. With this new Senior Savings Model in place, people who are dependent on insulin now have predictable costs and stable prices for their insulin supplies.