Medicare Plans Offer New Discounted Insulin Prices, or Do They?

Medicare Prescription Drug Plans that are sold by private insurance companies in Medicare Advantage Plans and stand-alone Part D plans for people with Original Medicare and Medigap plans are funded largely under contracts with the federal government using taxpayers funds.

Here’s are 3 things in the fine print you need to know.

1. The new pre-election announcement of a “Part D Senior Saving Program” that lowers your out-of-pocket co-payments for insulin, doesn’t begin until January 1, 2021 and doesn’t include the millions of Americans who use insulin every day but are not on Medicare.

2. The progam is optional for government-funded Medicare plans to participate in and the specific insulin that your doctor prescribes for you may not be included in the plan that you select.

To illustrate, in the upstate NY, we have 30 Medicare Advantage plans offered by 5 different insurers. However, in reviewing the details of their plans, only Excellus BCBS and United Healthcare have chosen to participate in this special option that will benefit seniors and disabled people who need insulin to live.

The other insurers who sell federally subsidized Medicare plans but chose not to participate in this insulin option include: Aetna, Wellcare and MVP (a regional insurer).

In drilling down deeper into the participating plans of Excellus and United Healthcare, a few other differences were noted.

Excellus: offers 5 Medicare Advantage plan that have monthly premiums ranging from $0 to $255. However only the three of the higher prices plans ($79, $157 & $255/mo.) are participating in the savings program. The two plans with either $0 or $39 monthly premiums are excluded.

So, individuals who enroll in a $0 or $39 monthly premium plan will be subject to a $380 or $300 deductible and a $42 a month/ $84 for three month supply of insulin from a preferred pharmacy.

By comparison, individuals who enroll in one of the three higher priced Excellus plans will not be subject to a deductible and will pay $25 a month/ $60 for 3 month supply of insulin from a preferred pharmacy.

United Healthcare: offers 4 plans with monthly premiums ranging from $0 to $79 a month. All of their plans include the insulin saving plan with an insulin cost of $35 a month/$95 for 3 months from a preferred pharmacy until you enter the catastrophic phase of medication expenses.

Finally note….always confirm that all your health care providers participate in any health insurance plan you are considering and that the medications that your doctor and you feel work best for you are also included in the plan’s formulary.

And, don’t be distracted with the marketing of $0 premium plans and extra free benefits that you may never qualify for or use. Spend some time shopping and comparing plans based on your most critical health care needs and the cost you’re likely to experience in the coming year.

There are two common problems that I see with clients….some are gamblers and they are under-insured even when they can afford to be safer.

And there are others that are too complacent and continue to stay with the same insurer/plan for 10 plus years even when their needs and income have changed. They are spending too much on insurance and don’t have enough money for other basic needs.

Look at the options that are available to you and make a choice that allows you to sleep at night.

Best wishes and stay safe and well.

Jim Sorrentino

Is It Too Late to Change your Medicare Plan?

Although the Medicare Annual Enrollment Period (AEP) ended on December 7th, you still may be able to make some important changes to your Medicare plan. The AEP runs from October 15 to December 7th and allows Medicare subscribers to enroll, disenroll  or switch their Medicare Advantage Health and/or Prescription Drug Plans (PDP). Common reasons for switching plans include significant changes in the costs access or coverage; plan terminations by the insurance company or employer group; and dissatisfaction with the plan’s administration. From January 1 to February 14, Medicare Advantage subscribers also have the opportunity to disenroll from their Medicare Advantage plan (MADP) and return to original Medicare with the option of adding a stand-alone Prescription Drug Plan (PDP). You may also be eligible to enroll in a Supplemental or Medigap plan at that time. Some reasons that people use this option is they didn’t make the needed changes during the earlier AEP or they selected a MA plan in January and it’s not meeting their needs. If you did not enroll in Medicare Part B (outpatient services) and/or Medicare Part D (prescription drugs) when initially eligible or during a Special Enrollment Period (SEP) and you did not have “creditable” insurance coverage (as defined by the Social Security Administration), you will likely be subject to a financial penalty if you want to enroll at a later date. In addition, your late enrollment will be generally restricted to the January to March, General Enrollment Period (GEP) and your coverage will not begin until July.  The prime take-away message is to read your mail from Social Security, Medicare and your insurance companies very carefully. It will save you time, money and reduce your stress and anxiety. If you need help understanding and acting on these matters, ask your trusted family members, friends, caregivers or an experienced Medicare counselor. For more general information, you can also call the Social Security Administration (800-772-1213), the Eldercare Locator (800-677-1116) and Medicare (800-633-4227). Feel free to share your comments and general questions, we all can learn from one another. Thanks Jim Sorrentino