The price of insulin for senior citizens with diabetes has long been a point of contention between consumers and insurance companies. CMS states, “One in every three Medicare beneficiaries has diabetes, and over 3 million use at least one or more forms of insulin.”
Medicare beneficiaries need a broad set of affordable insulins available to them, this has not been the case over the last decade. In fact, in 2001, one vial of insulin was available at $35, and in 2020 one vial can cost up to $250 a month.
Many senior citizens need more than one vial a month, and the price tag associated with insulin makes this almost impossible for someone living primarily off Social Security.
The White House announced a plan to cut insulin prices in 2021. The Trump Administration introduced the new Part D Senior Savings Model, and it is predicted to save seniors 66 percent in out-of-pocket spending.
The Part D Senior Savings model will lower the out-of-pocket insulin costs starting in 2021. With standardized payments negotiated with the pharmaceutical companies, the risk of Medicare fraud and its pertinence to insulin will ideally decrease.
This Model will improve the Part D program and give seniors a broader range of insulin providers with lowered costs.
There will be more than 1,750 Medicare Part D prescription drug plans available in 2021. Medicare Advantage plans with Part D coverage have also applied to offer lower insulin costs in the upcoming year. The Model is ensuring lower cost-sharing will be provided through all participating Part D sponsors.
With that said, it is anticipated to have the new Part D Model to provide these options in all 50 states, including Puerto Rico and the District of Columbia. Participating Part D sponsors will offer beneficiaries various Part D plans that will provide senior diabetics a more comprehensive range of insulins, including vial and pen dosages for all forms of diabetes.
How the Model will affect insulin copays
CMS is authorizing that Part D will offer predictable and fixed copays for Medicare beneficiaries. With that said, the participating Part D plans across the nation will provide seniors with a maximum copay of $35 for a full month’s supply of insulin — this will be the biggest decline in seven years!
With the maximum copay being $35 a month, it will make a beneficiaries annual spending on insulin be $420 — which is equivalent to how much a senior can pay for a months’ worth! With that said, participating Part D sponsors can certainly lower the monthly cost. Since this is a competitive field, some plans will likely offer copays lower than $35.
How to enroll in Part D Senior Savings Model
The Annual Election Period is your time to enroll, drop, or change your Part D plan or Medicare Advantage plan. The AEP will open on October 15, 2020 and will close on December 07, 2020. Your new coverage will be effective on January 01, 2021.
The Medicare Plan Finder tool that you find on Medicare.gov will be updating to help beneficiaries identify the plans that are participating in the Model.
CMS is predicted to release Part D premiums, drug costs, and more information regarding the Model in September 2020. As CMS releases Part D costs in September, you will be receiving your Annual Notice of Change from your carrier. When you receive this, you will want to compare your current plan with the new plan you might enroll in. You will want to assure yourself that switching plans is the most cost-effective option for you.
This year’s Annual Election Period is one to look forward to with the new capped insulin cost. Senior citizens have burdened the hardship of insulin prices far too long, and 2021 will bring them the savings and variety of insulin that they deserve.