Good news for diabetics! In January, The Centers for Medicare & Medicaid Services (CMS) implemented its Part D Senior Savings Model (Model) to make insulin more affordable. Medicare eligible individuals have access to many types of insulin and should pay no more than a $35 copay for a 30-day supply!
This savings is only available if individuals are enrolled in a participating Medicare standalone Part D prescription drug plan or Medicare Advantage Plan. Be aware that not all Medicare plans chose to participate in the Model and covered insulins may differ among participating Part D plans!
Participating Part D plans offer choices that provide select types of insulin in the deductible, initial coverage, and coverage gap phases of the Part D drug benefit. The resulting savings could save beneficiaries an average of $446 in annual out-of-pocket costs in 2021! This consistent, predictable, and more affordable Model should increase access to insulins and contribute to an improvement in preventative health care. For insulin used in insulin pumps, there are two main types: tube and tubeless.
The Medicare Part B benefit covers 80% of the costs of insulin that tubed pumps use. Depending upon the type of Medicare coverage, a Medigap plan or Medicare Advantage Plan will generally cover all or part of the remaining individual’s 20% cost share. Tubeless insulin pumps are newer devices that utilize a patch containing several hundred units of insulin. These typically work with a smart device that monitors blood sugar levels and deliver a regulated amount of insulin. The Medicare Part D benefit is generally responsible for covering insulin costs associated with tubeless pumps.
In addition to the Model, residents of Guilford County who routinely check their blood sugar and take medications to control their blood sugar levels may quality for a Chronic Special Needs Medicare Advantage Plan (MAPD-CSNP). This MAPD-CSNP $0 monthly premium plan participates in the Model, offers $0-dollar copays for primary care and select physician specialists, provides a higher level of coordinated care, and dramatically lowers the cost for other prescription drugs needed to manage diabetes. In addition to paying less for medications and doctor visits, the CSNP also decreases costs for urgent care, emergency room, and hospitals stays. Diabetic supplies and podiatry care are also included.
To learn more about the Model and MAPD-CSNP plans, contact your local insurance professional and ensure he/she represents multiple insurance companies. They will be familiar with county specific plans and provide valuable guidance to help compare and contrast benefits. Look for an established company with Certified Senior Advisors (CSA®) who offer FREE consultations. The extra effort needed to understand available Medicare options could save thousands of dollars and improve the quality of life those with diabetes.