Insulin Coverage Through Medicare Part D

October 19, 2020 | Kari Mellone

Diabetes currently affects more than 3.3 million Medicare beneficiaries. Medicare Part D changes, specifically Insulin coverage and related expenses, are about to change. What does this mean for you? Your diabetes related out-of-pocket expenses may be lowered, with the right coverage through Medicare Part D. Twin City Underwriters breaks down the changes and what you can expect now from insulin coverage benefit and Medicare Part D.

What is Changing in Medicare Part D?

Beginning in 2021, The Centers for Medicare and Medicaid have announced additional savings on insulin for eligible enrollees. Medicare Part D prescription drug plans and Medicare Advantage plans with prescription drug coverage will now offer lower insulin costs as a component of Part D Senior Savings model for the 2021 plan year, in addition to the following changes:

• Additional therapeutic continuous glucose monitor (CGM) coverage for patients who synchronize their insulin devices with their smartphones
• Medicare Advantage plans to offer a broader range of supplemental benefits cost coverage like diabetes education programs, time with a nutritionist or transportation to a doctor’s appointment.

New Insulin Savings Model

Currently, out-of-pocket costs for insulin can fluctuate from month to month, in part due to the different rules applying for each phase of the Part D benefit. With the new insulin coverage rules, fluctuations in price are expected to be minimized.

The Part D Senior Savings Model is a voluntary model that tests the impact on insulin access and care by participating Part D enhanced alternative plans. The model seeks to offer lower out-of-pocket expenses on a broad range of insluin by providing a cap at a $35 copay for a 1 month supply. More information on the Part D Senior Savings Model can be found on the CMS website.

For a more detailed breakdown on Medicare Part D and other considerations, please visit Medicare.gov’s page on drug plans. If you need some help navigating Medicare’s website or are unsure what plan is best for you, contact us today to set up an appointment to go over your options.