Association of Diabetes Care & Education Specialists

JOIN ADCES

News & Publications

Navigating Medicare Open Enrollment and $35 Insulin Options

Nov 04, 2021

By Kate Thomas, ADCES Chief Advocacy and External Affairs Officer 

Medicare open enrollment runs from October 15 to December 7. During the time, Medicare beneficiaries can reevaluate their coverage for Original Medicare, Part D, or Medicare Advantage. They can make changes to their plan or purchase a new policy. This is an important time for beneficiaries to “shop around” and look at the costs of premiums, prescription drug coverage, pharmacies, plans, etc. 

Despite the importance of shopping around during the open enrollment period, a recent Kaiser Family Foundation analysis found that 7 in 10 beneficiaries (71%) said they didn’t compare their coverage options for the upcoming year. Plans change from year to year and that can lead to additional costs or disruptions in care. Providers can change networks, plans update their lists of covered drugs, and co-pay or cost-sharing requirements can increase. All of these are important factors for Medicare beneficiaries, especially those with diabetes, to consider as they consider their coverage options for the upcoming year. 

Diabetes care and education specialists (DCESs) can serve as a resource in assisting their patients in navigating the open enrollment period for Medicare. For 2022, there are important updates that impact Medicare beneficiaries with diabetes. Beneficiaries may not be aware of these changes, and DCESs can assist in directing their patients to the right information. 

Deciding on a Plan: Part D Senior Savings Model and $35 Insulin Options  

In 2021, Medicare launched the Part D Senior Savings Model which allowed beneficiaries to enroll in a participating plan to receive their insulin at $35 or less for a 30-day supply. Beneficiaries could identify a participating Part D plan through an “insulin savings” filter on the Medicare plan finder when selecting their plans. For 2022, the filter was removed, making it a little more difficult to understand exactly what plans are participating. 

Below is a list of detailed enrollment information. DCESs can assist their patients in understanding where to find the information they need to select a plan and how to identify a plan that is participating in the Part D Senior Savings Model. 

  • There are two options for selecting an overall plan in 2022. An online option- Medicare Plan Finder or by calling Medicare at 1-800-MEDICARE (1-800-633-4227) for help. Text telephone/ TTY users can call 1-877-486-2048. A beneficiary can also search for Medicare Advantage Plans or Part D Prescription Drug Plans that will provide the <$35 /month insulin savings in 2022 using this site: https://q1medicare.com

  • Factors to consider when evaluating plans include premium costs, making sure the beneficiary’s providers are in-network, insulin and non-insulin medication costs, and the pharmacies available in the plans. 

  • On Medicare Plan Finder, beneficiaries will log-in with an existing account or create an account. The beneficiary can also use the system as a guest by entering their zip code and coverage options (original Medicare and/or Part D or Medicare Advantage). 

  • The beneficiary will be promoted to answer a few other questions, including if they want to see drug costs when comparing plans. They should answer “yes” and enter all of the prescription drugs they take including the dosage, quantity, package, and frequency. Do this for all medications, not just insulin. 

  • Then, they’ll be promoted to enter their mailing address and preferred pharmacies (select up to 5). 

  • Next, they’ll be able to compare plans. They can sort plans by lowest drug and premium costs, lowest monthly, premium, or lowest yearly drug deductible. 

    Graphical user interface, text, application, email Description automatically generated 

  • Click on “Plan Details” to see more about the plan including drug coverage information. You can also click “add to compare.”

     Graphical user interface, application, Teams Description automatically generated 

  • One they click on the plan details, they can look at yearly drug costs based on the medications you take and the pharmacies:  

    Graphical user interface, application Description automatically generated  

For DCESs, it is important to encourage your patients to compare plans and costs based on the medications they take, including insulin, and their overall out-of-pocket costs. Medicare beneficiaries can explore different plan options to select a plan that best meets their needs. Though a DCES likely won’t assist an individual in selecting a plan, you can support a person with diabetes in knowing what to look for and making them aware of the Part D Senior Savings Model and insulin options. 

List of Participating Plans and List of Discounted Insulins/Insulin Combos for 2022:  

  • Beneficiaries and providers can view a list of plans participating in the Part D Senior Savings Model by clicking here

  • Beneficiaries and providers can view the list discounted insulins/insulin combo drugs for 2022 here

Where to Find Assistance:  

  • Beneficiaries can call Medicare at 1-800-MEDICARE (1-800-633-4227) for help. Text telephone/ TTY users can call 1-877-486-2048. 

  • CMS-trained Counselors with the State Health Insurance Assistance Program (SHIP) can also provide unbiased help to compare Medicare plans that offer the discounted insulins. Click here to find the local SHIP in your area.  

Additional Information:  

  • Medicare beneficiaries with diabetes should look at the different plans to ensure they are selecting a plan with the lowest premiums and the lowest costs for insulin ($35 or less) per type of insulin you take and other non-insulin medications. If you take two types of insulin, this will mean the cap is $35 per insulin (2 x $35). 

  • For a plan participating in the Part D Senior Savings Model, $35 will be the maximum. The beneficiary may see insulin costs lower than $35. 

  • A beneficiary does not have to separately enroll in the Part D Senior Savings Model. They just need to select a participating plan. 

  • If a beneficiary participated in a Part D Senior Savings Model plan in 2021, they will be contacted about re-enrolling in that plan for 2022. 

Medicare Advantage Special Needs Plans (SNPs): 
  • A Medicare Advantage SNP may be an option for people with diabetes or other chronic conditions. Beneficiaries can search “C-SNPs” on q1medicare. Click here to learn more about C-SNPs and the two other types of SNPs - for Medicare beneficiaries who are also eligible for Medicaid (dual eligible) and those who reside in an ”institution”. One can also search by state and then county on this website to locate any of the SNPs that might be available. The three types of SNPs include drug coverage that offers most brand name drugs on the plan’s formulary at a discount. Switching from Original Medicare or from a Medicare Advantage Plan into an SNP can be done at any time of the year. This is especially important for someone diagnosed with diabetes outside the Open Enrollment Period.  

Resources


ADCES Perspectives on Diabetes Care

The Association of Diabetes Care & Education Specialists Perspectives on Diabetes Care covers diabetes, prediabetes and other cardiometabolic conditions. Not all views expressed reflect the official position of the Association of Diabetes Care & Education Specialists.

Copyright is owned or held by the Association of Diabetes Care & Education Specialists and all rights are reserved. Permission is granted, at no cost and without need for further request, to link to, quote, excerpt or reprint from these stories in any medium as long as no text is altered, and proper attribution is made to the Association of Diabetes Care & Education Specialists.

HEALTHCARE DISCLAIMER: This site and its services do not constitute the practice of medical advice, diagnosis or treatment. Always talk to your diabetes care and education specialist or healthcare provider for diagnosis and treatment, including your specific medical needs. If you have or suspect that you have a medical problem or condition, please contact a qualified health care professional immediately. To find a diabetes care and education specialist near you, visit DiabetesEducator.org/Find.

In This Section

News & Publications