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Part D Senior Savings Model

A large percentage of Americans have diabetes. In fact, according to CDC, over 34 million Americans live with it. Another study shows that more than 9 million seniors (65 years and older) have diabetes. It is also common knowledge that insulin is needed to treat diabetes. And even though insulin has been around for a long time, it is still costly.

Previously, even people with Medicare have to pay a lot of money to get the insulin they need for their treatment. However, things are now changing as CMS has designed a plan called Part D Senior Savings Model. The Part D Senior model is designed to make it easier for seniors to have access to insulin which is vital to their diabetes treatment. Here, we will be telling you how this plan makes things easier and what enrollees stand to gain from this plan.

Why Part D Senior Savings Model Is Beneficial To Seniors

As we have said previously, insulin is essential for the management of diabetes. And although it is vital, some of those that need it find it hard to access it. Because of this, there is a high chance of serious complications ranging from vision loss and chronic kidney disease to foot ulcers that can lead to amputation. But, since insulin is usually expensive, Medicare beneficiaries with diabetes often ration insulin or sometimes go without it completely, which can be very dangerous for them.

However, with the emergence of the Part D Senior Savings Model, beneficiaries will have better access to any type of insulin they need. This, in turn, leads to better treatment of diabetes. The plan will help Medicare Beneficiaries with the Part D Senior Model get an insulin price cap of $35 per month. This means that participating seniors will get a 30-day supply of insulin for a maximum cost of $35.

Moreover, any enrollee who chooses a model participating plan will not have their insulin prescription subject to a deductible or coverage gap cost increase. Another benefit of the Part D Senior Savings Model to seniors is that insulin users can save up to $446 annually for out-of-pocket medication costs. So, although Part D Senior Savings Model attracts a higher premium, it can be cost beneficial to seniors in the long run.

Who Is This For?

Part D Senior Savings Model is only restricted to Medicaid Part D enrollees. This is because the federal government doesn't have regulatory powers over insurance practices for commercial Medicaid. However, it has control over Medicare Part D or Medicare prescription drug benefit. Because of this, if you want to enjoy this plan's benefits, you will need to enroll for Medicaid Part D first.

Will All Health Insurance plans Cover All Types Of Insulin Under This Model?

Each plan offers different types of insulin. This is why it is important that you review your plans to ensure that the plan you are choosing provides the insulin you need. Moreover, you can use the Medicare Plan Finder to find a suitable plan with the drugs/insulin for you. It is also advisable that you compare all the plans in the search carefully (including the ones that do not participate in the insulin savings program). Depending on the cost of other drugs you take, you might find a plan that is not as expensive as the Senior Savings Model.

Will Medicare’s $35/Month Out Of Pocket Cap For Insulin Affect Pricing policy On Insulin In The Long Run?

What this model aims to achieve is to solve the unpredictability of out-of-pocket costs that Part D enrollees pay for insulin. When this is done, enrollees will have steady, constant, and affordable access to insulin. It is also not new that Medicare policies tend to have a significant influence on commercial coverage plans. In light of this, there is hope that commercial prescription drug plans will make the necessary changes to make insulin copays more affordable for their enrollees.

My Final Word

You see, with the Part D Senior Savings Model, seniors do not have to worry about exorbitant insulin costs anymore. All seniors can enroll in this plan to get a maximum cap of $35 on out-of-pocket costs of insulin monthly. However, it is essential to check that the plan you enroll in offers the insulin you need.


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