 |
| Lower Medicare insulin co-pays could benefit many people. |
This week, Baby-Boomer-Retirement is delighted to have a guest post from Medicare Supplement expert Danielle Kunkle Roberts, founder of Boomer Benefits, the 5-Star rated Medigap agency she founded. In her guest post, below, she explains how the new cap on insulin co-pays for Medicare beneficiaries could benefit you.
Insulin Co-pays Capped at $35 for Medicare Beneficiaries - What You Need to Know
by Danielle Kunkle Roberts
Diabetes has been around for centuries, inciting major health
problems for those impacted by the disease. According to the CDC, nearly 80,000
deaths a year in the U.S. can be attributed to diabetes. This makes diabetes the
seventh leading cause of death in America.
For many people, insulin is a lifeline for controlling their
diabetes, enabling them to live a somewhat normal life. When taking a closer
look at seniors with diabetes, specifically, there are over 3 million Medicare
beneficiaries who use at least one form of insulin.
In 2020, one vial of insulin can cost up to $250 and some
seniors need more than one vial a month. The co-pays for insulin can fluctuate
throughout the year. The inconsistency of costs can make it challenging for
someone on a fixed income to budget, and can often make it difficult for them to afford their insulin.
Fortunately, there is great news coming for Medicare
beneficiaries in 2021. After many years of calls for reform in the
amount senior diabetics pay for insulin, legislation has been put into place
that will drastically reduce the out-of-pocket costs for seniors.
Part D Senior Savings Model
Nearly 10,000 people age into Medicare each day, and 1 out of 3 beneficiaries have diabetes. Even with a national program like
Medicare, many beneficiaries are left paying high out-of-pocket drug costs.
On March 11, 2020, the White House made an announcement which
introduced the Part D Senior Savings Model. The Part D Senior Saving Model will
work with the major drug manufacturers of insulin to dramatically reduce the
cost of insulin to Medicare, and then pass those savings to beneficiaries in
the form of lower co-pays.
The Centers for Medicare and Medicaid Services, or CMS, is encouraging Part D sponsors to offer fixed and
predictable co-pays for insulin. The federal government has entered into partnerships
with drug manufacturers and created a plan to ensure lower, consistent co-pays can be deliverable.
With the predictable cost of insulin, it is estimated that
there will be a 66 percent decrease in out-of-pocket spending for Medicare
beneficiaries.
What to expect in 2021
The response to the restructuring of insulin co-pays under Medicare
Part D has been positive from most of the players involved. Along with many
of the major insulin manufacturers, 88 private insurance companies and over
1,700 Part D and Medicare Advantage plans have agreed to participate in the new Senior Saving Model.
The plans which participate in the Model will have government
regulated requirements they must follow. For example, all participating
sponsors must provide both pen and vial dosage forms for the four types of
diabetes in the drug formulary. Additionally, the drug manufacturers which
participate in the Model must include all marketed drugs that contain insulin,
no exclusions.
As of 2021, Medicare beneficiaries who are enrolled in one of the
participating plans will receive a 30-day supply of insulin for no more than $35
out-of-pocket. Predictions estimate that beneficiaries who use insulin will
spend around $420 annually, which is a colossal savings when compared to the fact
that many seniors currently pay that much every month.
The last bit of good news on this is that private plans like
Part D and Medicare Advantage plans are competitive among carriers. That said, it
is likely you will find plans that are offering co-pays less than the $35 max in the
upcoming Annual Election Period.
Enrolling in Part D
In September 2020, the Centers for Medicare and Medicaid Services, or CMS, will release the premiums and co-pays
for the participating plans. During this time, you will want to utilize the
Medicare Plan Finder tool on Medicare’s website. This tool has been updated to
filter out the non-participating plans in the Part D Model, which will make it
easier for you to find a plan which is a part of the Model.
The Annual Election Period is when a beneficiary can change,
switch, or drop their Medicare Advantage or Part D plan. The AEP will begin on
October 15, 2020 and end on December 07, 2020. You will receive an Annual
Notice of Change in the fall, and you will want to thoroughly examine it to
ensure the Model’s plan has more to offer before you enroll.
In 2021, Medicare beneficiaries will finally receive their
insulin at a reasonable price that is long overdue. CMS has mentioned that
if this insulin savings model turns out to be a success, they hope to eventually
expand it to other drugs. When researching the different plans, make sure you
choose the most cost-effective option that covers the medications you need.
About Danielle Kunkle Roberts: She is a founder of Boomer Benefits and a frequent contributor to the Baby-Boomer-Retirement blog. Her 5-Star rated company is a member of the National Association of Medicare Supplement Advisors and the National Association of Health Underwriters. They are licensed in 48 states. Several readers of this blog, as well as some of my personal friends, have used her agency and been very satisfied with the assistance they received. You can contact them at 855-732-9055.
Are you confused about how to get the most out of Medicare? You are not alone. You may find it helpful to get the handy reference book, "Maximize your Medicare: 2020-2021 Edition." It provides useful information which will quickly answer common questions. (Ad)
Disclosure: This blog may contain affiliate links. If you decide to make a purchase from an Amazon ad, I'll make a small commission to support this blog, at no extra cost to you.
You are reading from the blog: http://www.baby-boomer-retirement.com
Photo credit: Pixabay
