$35 Insulin Copay for Medicare Recipients

by | Jul 20, 2020

According to the American Diabetes Association, 1 in 3 Medicare recipients have diabetes. If you’re a diabetic, you know insulin costs have skyrocketed in the past decade. It has increased 55% since 2014. Insulin copays are a huge financial burden, even at heavily discounted prices and large drug store chains.

In late May, Seema Verma, head of the Centers for Medicare and Medicaid Services (CMS) announced that Medicare beneficiaries with diabetes will pay $35 copay for a 30-day supply of most insulins. The new drug program can be a savings of $446 and is funded by drug manufacturers, in part. The Senior Savings Model is between the major insurance companies and insulin manufacturers like Eli Lilly, Novo Nordisk and Sanofi. Verma said 1,750 insurance plans offered in 2021 to Medicare recipients have agreed to provide the drugs at the new copay.

Covered insulins will not be subject to deductibles or the donut hole, where copays continue to the catastrophic phase after which 5% coinsurance would begin. This will not change the already low copays in Medicare Advantage Special Needs Plans and PACE. Insurance companies are not required to include all insulin types but must minimally offer one form of the pen-dosage and vial-dosage for each type of short-acting, intermediate-acting, long-acting, and rapid-acting insulin. It will be offered through enhanced plans that may cost more per month. The cap on copays is expected to lead to a small increase in premiums. The new program will be effective in January 2021 PDP prescription drug and Medicare Advantage plans. Getting the healthcare you need to monitor diabetes is unpredictable and expensive. Even with Medicare’s great benefits. The most important thing you can do to protect your health is find the right fit for your medical needs. Be sure to review your Part D or Medicare Advantage Plan prescription coverage with a reputable, licensed agent. Any necessary changes can be made during the annual open enrollment period, which begins October 15, 2020 through December. 7, 2020 for an effective date of January 2021.

Join me next time as we continue our Medicare discussion. Stay safe and be well.

About Dayna Schafer

I’m a licensed, professional Medicare advisor. My agency is located in St. Petersburg, FL where we have helped over a thousand Medicare beneficiaries navigate the Medicare enrollment process since 2002. We painstakingly are appointed with more than the average amount of insurers to relentlessly seek out the right fit for your healthcare needs.

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