Saturday, June 27, 2020

Insulin Co-pays Capped at $35 for Medicare Beneficiaries in 2021 - What You Need to Know

Lower Medicare insulin co-pays could benefit many people.
Drug prices continue to be a concern for many senior citizens.  In particular, the cost of insulin has been a problem for several years, as prices have increased, often placing a heavy burden on retirees who are living on a fixed income.  Fortunately, help is on the way in 2021 for the millions of diabetic retirees who are dependent on insulin. 

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)

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