Medicare Part D Senior Savings Model: An Overview

Medicare recipients who take insulin to control their diabetes know the cost for this life saving medication in previous years has become outrageous.  A vial of insulin can cost patients as much as $250, and some people require multiple insulins per month. The average person simply can not afford these prices without aid. 

There are two ways Medicare eligible individuals can get coverage for their prescriptions. 

Part D Prescription Drug plan- an insurance plan which helps pay for prescriptions only.

Medicare Advantage plan (Part C) - combines all their health care coverage through a private insurance plan and typically includes prescription drug coverage in the policy.  

With either option Medicare coverage for prescriptions includes out of pocket costs at the pharmacy based on the drug plans copayments or coinsurance for medications.  Additionally some plans have a deductible of up to $445 which applies to insulin before coverage begins.  Many Medicare beneficiaries have high costs for their medications and insulin has been one of the largest out of pocket expenses. 

This year, in response to the rising price of insulin, the Centers for Medicare & Medicaid Services (CMS) introduced the Part D Senior Savings Model. This program reduces the out of pocket cost for a 30 day supply of insulin to $35!  

How Does the Senior Savings Model work with Medicare Part D?

While Medicare drug coverage is designed to reduce regular prescription medication costs, the Senior Savings Model specifically keeps copayments for insulin at a low and manageable level. The Senior Savings Model was launched January 1st 2021.  What the Senior Savings Model does for insulin is:

• Bring copayment for 30-day supply of insulin down to $35 a month at the highest.
• You must be enrolled in a Part D Prescription Drug plan or Medicare Advantage plan which participates in the program. In New Jersey there are only 9 Part D Prescription Drug plans which work with the Senior Savings Model.  There are 10 Medicare Advantage plans which participate, however availability of these plans depend on the county you live in.  

What to Do When You Have Questions About Medicare Part D and Other Medicare Plans

The landscape of Medicare coverage is constantly changing, with new rules appearing every year and plans changing as the laws change. If you have specific questions regarding your current Medicare coverage or problems that need addressing, such as if you are choosing the right Medicare Advantage and Part D plans that meet your individual needs, contact New Jersey Medicare Brokers, where experts in your area are available to assist you.