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Do You Take Insulin? There is a New Medicare Part B Coverage Change

October 19, 2023

Beneficiaries have all of 2023 to switch plans for a lower price on that Diabetes treatment

Starting in 2023, Medicare Beneficiaries who rely on Insulin were greeted with some welcome news - a significant change in Medicare Part B Coverage. Effective January 1, 2023, a groundbreaking reform ensures that the cost of Insulin for Medicare Beneficiaries is capped at an affordable $35 for a one-month supply of each Part-D covered Insulin product. Additionally, this change eliminates the need to pay a deductible for Insulin, providing much-needed relief for millions of Americans grappling with the rising costs of healthcare.

Here is a comprehensive breakdown of the Medicare Part B Coverage change and its implications for Insulin-Dependent Beneficiaries.

Affordable Insulin for All
The most notable change is the cap on Insulin costs. Regardless of your income level or whether you receive Extra Help to lower your prescription drug costs, you will now pay no more than $35 for a one-month supply of each Part-D covered Insulin product. This represents a significant cost reduction, especially for those who rely on multiple types of Insulin to manage their Diabetes.

For those who prefer the convenience and cost savings of obtaining a three-month supply of Part D-covered Insulin, the maximum cost remains budget-friendly at $105, which translates to $35 for each month's supply. This pricing structure ensures that beneficiaries can maintain a consistent supply of this life-saving medication without breaking the bank.

Disposable Insulin Patch Pumps
If you use a Disposable Insulin Patch Pump, rest assured that this change applies to you as well. Insulin for your pump will not cost more than $35 for a one-month supply of each covered Insulin product, ensuring that this advanced technology remains accessible and affordable for those who rely on it.

However, it's essential to note that if your Part D plan covers Disposable Insulin Patch Pumps, the pump itself is considered an Insulin supply. Consequently, it is not subject to the $35 cap and might cost more than $35. Therefore, beneficiaries using this technology should carefully review their plan to ensure they are fully aware of the costs associated with their Insulin Pump.

Special Enrollment Period for Exceptional Circumstances
Medicare understands that circumstances change, and beneficiaries may need to adjust their coverage accordingly. If you use a covered Insulin product and wish to switch to a different Part D plan for 2023, you may qualify for a Special Enrollment Period (SEP) for Exceptional Circumstances. This SEP allows you to add, drop, or change your Part D coverage once between now and December 31, 2023.

To take advantage of this opportunity, simply call: 1-800-MEDICARE (1-800-633-4227). TTY users can call: 1-877-486-2048. Importantly, if you decide to change plans mid-year, your True Out-of-Pocket (TrOOP) costs will carry over from your old plan to your new one, ensuring a seamless transition.

Further Improvements Effective July 1, 2023
The positive changes in Medicare's coverage for Insulin do not end with the start of the year. Effective July 1, 2023, additional improvements come into effect, further alleviating the financial burden on beneficiaries.

If you use an Insulin Pump that falls under Medicare Part B's durable medical equipment benefit, or if you receive your covered Insulin through a Medicare Advantage Plan, your Insulin costs will be capped at $35 for a one-month supply. The Part B deductible will no longer apply to Insulin, making it even more affordable for beneficiaries.

For those with both Part B and Medicare Supplement Insurance (Medigap) that covers Part B coinsurance, your Medigap plan should take care of the $35 (or less) cost for Insulin, providing comprehensive coverage that ensures access to affordable medication.

Access to Information and Support
The new Medicare Part B coverage change, effective January 1, 2023, marks a significant step forward in making Insulin more affordable and accessible for Medicare beneficiaries. With a cap on Insulin costs at $35 for a one-month supply and the removal of the deductible, this change promises to ease the financial burden on individuals managing Diabetes. Furthermore, the improvements that became effective as of July 1, 2023, ensure that beneficiaries using Insulin pumps and Medicare Advantage Plans also benefit from these cost-saving measures.

It's crucial for Medicare beneficiaries to stay informed about these changes, and Medicare has made resources and support readily available to assist with any questions or concerns. With these reforms, Medicare continues its commitment to providing comprehensive and affordable healthcare coverage for millions of Americans who rely on Insulin to manage their health and well-being.

Medicare wants to ensure that beneficiaries are well-informed about these changes and can access the support they need. If you have questions or need more information about Medicare's coverage and your costs for Insulin, you can visit: - Or call: 1-800-MEDICARE (1-800-633-4227). TTY users can call: 1-877-486-2048.

Knowledge is power, and understanding these changes is essential for making the most of your healthcare coverage.

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