Eileen Doherty
According to the Centers for Disease Control, the sixth leading cause of death is diabetes among individuals age 65 and over. Type 1 diabetes means the body does not produce insulin, while Type 2 diabetes means the body is processing insulin incorrectly. Twenty percent of people over age 65 have diabetes.
The Center for Medicare and Medicaid Services has launched the Senior Savings Model, a new program to limit out-of-pocket costs for insulin. Insulin can cost thousands of dollars per year for many individuals. Even individuals who have Medicare Part D plans often face high costs as insulin can be a Tier 4, 5, or 6 drugs resulting in Medicare beneficiaries often paying 50% of the cost of the drug out-of-pocket.
Participation in the Senior Savings Model is voluntary by the prescription drug plans and the Medicare Advantage companies; thus, not all plans offer the $35 per vial co-payment in Colorado.
Most prescription drug plans in Colorado follow the standard prescription drug benefit. As such the first $445 of the retail cost of prescriptions is paid by the beneficiary. The beneficiary then pays 25% or about $2500 of the next $10,178 retail charges for prescriptions through the donut hole. When the retail costs of prescription drugs exceed $10,178 and the individual reaches catastrophic coverage, the individual then will be responsible for paying $3.70 for generic drugs costing less than $74 or 5% of the cost of the drug costing more than $74. For brand-name drugs in the catastrophic coverage, the beneficiary will pay $9.20 for drugs with a retail cost under $184 or 5% of the cost of drugs costing more than $184.
If a beneficiary needs only one vial of long-acting and one vial of short-acting each month, the beneficiary should see significant savings and only have to pay $35 for the long-acting and $35 for short-acting insulin per month. However, if a beneficiary needs two vials of each, the monthly retail cost may be significantly higher depending on the tier, the quantity limits, and other co-pays.
Use the plan finder at www. medicare.gov to review your estimated out-of-pocket costs, based on your insulin needs to realize as many savings as possible.
Medicare Part B also pays for diabetic supplies such as lancets and test strips that are purchased at a Medicare Part B participating provider. While beneficiaries may be able to purchase supplies at a pharmacy in a grocery store, that pharmacy may not be a Medicare Part B participating provider.
November is American Diabetes Month. While diabetes is preventable, treatment includes physical activity, a healthy diet, and weight control.
For information on risk factors, prevention, and ways to manage diabetes, visit us at www.senioranswers.org or call 303-333-3482.
~ Eileen Doherty, MS is the Executive Director of the Colorado Gerontological Society and teaches Nonprofit Management for Fort Hays State University. She can be contacted at 303-333-3482 or doherty001@att.net