For the millions of Americans with diabetes, paying for insulin can be an ongoing struggle. According to the CDC, approximately 25% of people aged 65 or older have diabetes. Now, a new Medicare program can help these individuals save on insulin – but only if they enroll in a plan that is participating in the program.
If your clients have diabetes, help them find a Medicare plan that will provide insulin savings in 2021.
The Senior Savings Model
CMS says that 3.3 million Medicare beneficiaries use at least one of the common forms of insulin to manage diabetes. To help these beneficiaries afford their medicine, CMS has introduced the Senior Savings Model.
Under the Senior Savings Model, beneficiaries will not pay more than $35 for a month’s supply of insulin through participating Medicare Advantage Prescription Drug and standalone Medicare Part D coverage. A broad set of insulins will be included in the program.
The $35 cap will apply to all four phases of Medicare Part D payments. As a result, enrollees will not pay more than $35 even if they are still paying the deductible or they have reached the coverage gap. This will make insulin costs both more consistent and more affordable, which will help retirees who are living on a fixed income.
Beneficiaries who use insulin and join a participating plan are expected to save an average of $446 in annual out-of-pocket costs.
Find a Participating Plan
The Senior Savings Model is a voluntary model, and not all plans will be participating.
When comparing Medicare plans during the annual election period, it is always important to enter the beneficiary’s prescriptions to check for coverage and costs under each plan’s formulary. This year, you should also be on the lookout for plans participating in the new Senior Savings Model.
You can look for participating plans using Medicare’s Plan Finder tool. CMS has added a filter called “Insulin savings.” You should see this option in the top right corner when you get to the list of plans in your area. Check the box if you only want to see plans that are participating in the Senior Savings Model.
If you are using the Q1Medicare Plan Finder, scan the plan results in your area for green text that says “insulin coverage $35 or less” to find plans that are participating in the Senior Savings Model.
CMS says that 1,635 Medicare Advantage Prescription Drug plans and Medicare Part D plans are participating in the Senior Savings Model in 2021.