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New Medicare Model Offers Savings On Insulin Prescription

Question: How may insulin be less expensive in 2021?

Answer: Insulin has been very expensive for a number of years. I have seen many Medicare eligible people spend thousands of dollars each year to pay for their insulin. This year the Centers for Medicare and Medicaid Services (CMS) has developed a new Model, the Part D Senior Savings Model, so 2021 will be different. This model provides an opportunity for insurance companies to offer a significant savings to their enrollees on the types of insulin the insurance company includes on their formulary. The participating plans will offer co-pays of $35 or less for a 30-day supply of insulin during the deductible, initial coverage, and coverage gap phases.

In Chautauqua County, there are 11 Medicare Advantage Plans and eight Prescription Drug Plans (PDPs) that are offering the model as part of their coverage which includes insulin on their formulary at the cost of $35 per month or less. There are some plans that are offering as low as $11 for the insulin covered on their formulary.

As enrollees move through the phases of coverage, they will see a consistent pricing structure at the pharmacy for their insulins covered on the formulary. They want to be sure to evaluate their drug coverage this year. Finding a plan using the medicare.gov website could save people hundreds, maybe thousands of dollars.

It is also worth noting that those plans participating in the model are not required to cover all types of insulin at this cost structure. The enhanced coverage will be extended to those insulins they normally cover on their formulary. So Medicare enrollees need to be sure to evaluate the Part D plans available to be sure they are choosing and enrolling in a plan that covers the insulins they take.

The annual open enrollment period, which started Oct. 15 and ends Dec. 7 is important to those Medicare recipients on Insulin. You can compare your current plan with all the plans available to get your best possible savings. For those on Medicare who are not comfortable using a computer, you can call 1-800-MEDICARE (1-800-633-4227) to get assistance 24 hours a day, seven days a week.

When you evaluate your options and find a plan that participates in the Senior Savings Model, you can enroll in that plan to begin Jan. 1, 2021, and that’s when the savings will begin.

The annual open enrollment period is the designated time to evaluate your current coverage in comparison with all the other plans available. This is the time to be sure that your current coverage covers all your medications and to see if any other plan is offering better savings to you if you enroll in its plan.

Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions, concerns, call 720-9797 or e-mail SLM@lutheran-jamestown.org.

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