INSURANCE

Q: What’s going on with the cost of insulin for those of us on Medicare? It’s one of my biggest medical expenses.

A: Beginning in 2021, beneficiaries of some Medicare Part D or Medicare Advantage Plans who use insulin will pay a maximum co-pay of $35 for each one-month supply of this lifesaving drug. This is good news for the more than 3.3 million Medicare beneficiaries who use one or more forms of insulin.

Under the current plans, Medicare Part D coverage is divided into four stages with the cost of insulin fluctuating in each stage. The four coverage stages are divided as follows: Stage 1 - Annual Deductible, Stage 2 - Initial Coverage, Stage

3 - Coverage Gap, and Stage 4 - Catastrophic Coverage. Now, Medicare Part D beneficiaries pay 25% of the overall cost of insulin once they reach the coverage gap. The Center for Medicare Services estimates the average out-of-pocket cost for insulin each year at $675.

The new Medicare $35 per month cap will be applicable in all four stages of Medicare, so insulin costs will not be subject to the annual deductible or higher costs during the coverage gap stage.

More than 1,750 Medicare part D plans and Medicare Advantage plans will be offering these lower prices with plans going into effect on January 1, 2021. It is important to remember not all plans will participate in this program. It will be up to you and your insurance agent to determine if your 2021 plan will include the $35 per month cap on insulin.

The Medicare Annual Enrollment Period runs from October 15, 2020, through December 7, 2020. This is the time for you to switch to a Medicare Advantage plan or a Part D Prescription Drug plan that provides this benefit. New plans will go into effect beginning January 1, 2021. If you have questions or would like to find health insurance that is a better fit for your needs, call me at 440-255-5700 or Lmutsko@mutskoinsurance.com. We will set up a time to meet concerning your situation.