Lower Insulin Costs for Medicare’s Seniors

One In Every 3 Medicare Beneficiaries Has Diabetes

In the United States, 3.3 million Medicare beneficiaries use one or more of the common forms of insulin. For many of them, insulin is critical for their health management. Unfortunately, the costs of insulin can be too much to afford and leaves beneficiaries to go without treating their condition.

According to cms.gov, the Centers for Medicare & Medicaid Services (CMS) announced that over 1,750 standalone Medicare Part D prescription drug plans and Medicare Advantage plans with prescription drug coverage have applied to offer lower insulin costs through the Part D Senior Savings Model for the 2021 plan year.

​What this means to Medicare beneficiaries is that access to a insulins will be at much predictable cost rather than subject to a percentage projection. Beneficiaries will have access to a broad set of insulins at a maximum of $35 copay for a month. Typically individuals that take insulin would be subject to the coverage gap sometime during the year and would be responsible for 25% of the cost of their insulin at that point. What will happen starting the 2021 plan year, is that insulin will no longer be subject to the coverage gap and instead will be at the predictable cost of no more than $35 for the whole year.

Sited by the Centers for Medicare and Medicaid Services, for the first time, CMS is enabling and encouraging Part D plans to offer fixed, predictable copays for beneficiaries rather than leaving seniors paying 25 percent of the drug’s cost in the coverage gap. Both manufacturers and Part D sponsors responded to this market-based solution in force and seniors that use insulin will reap the benefits. 

Individuals taking insulin could see an average savings of $466, or 66%

It is anticipated that beneficiaries will have Part D and Medicare Advantage Plan options in all 50 states that will provide this benefit. Beneficiaries will be able to enroll during Medicare open enrollment, which is from October 15, 2020 through December 7, 2020, for Part D coverage that begins on January 1, 2021. 

Plan benefits will not be available for any 2021 Medicare plan until October 2020, but when it comes to that time, please feel free to reach out to us. We are contracted with every single plan in Southern Nevada and will be more than happy to discuss any changes to your existing plan or any other plan that you are interested in.

Give us a call or send us a message, we give unbiased answers to your Medicare questions.

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