The Medicare Agent Blog

4 Key Points to Help Beneficiaries Navigate Their Diabetes Journey Through Their Medicare Coverage

November marks Diabetes Awareness Month, an important time for Medicare agents to guide and support beneficiaries managing diabetes. Understanding recent Medicare coverage updates can make a significant impact on their health and financial well-being.

Understanding Diabetes

Diabetes, a widespread and intricate condition impacting millions worldwide, manifests as elevated glucose levels in the blood, posing various health risks if not effectively managed. There are 3 types of Diabetes:

  1. Type 1 Diabetes: An autoimmune condition necessitating lifelong insulin therapy due to the immune system attacking insulin-producing cells in the pancreas.
  2. Type 2 Diabetes: The most prevalent form, often linked to lifestyle factors, resulting in ineffective insulin use or production, leading to elevated blood sugar.
  3. Gestational Diabetes: A temporary form occurring during pregnancy, resolved post-childbirth, yet escalating the risk of developing type 2 diabetes later.

How you can assist your Medicare Clients

Here’s a breakdown of 4 key points of information to empower you in assisting your Medicare beneficiaries:

1. Part D Coverage for Insulin: Affordability for All

As of January 1, 2023, Medicare beneficiaries enjoy a breakthrough in insulin affordability:

  • A one-month supply of each Part D-covered insulin product is capped at $35.
  • No deductible applies to insulin costs.
  • This $35 limit holds true, even for those receiving Extra Help to lower prescription drug costs.
  • Opting for a 3-month supply? Your costs won’t exceed $105, ensuring continued financial relief.

2. Disposable Insulin Patch Pumps: Cost Control Continues

For beneficiaries using disposable insulin patch pumps, the good news continues:

  • Insulin for your pump remains affordable at $35 for a one-month supply of each covered insulin product.
  • Note: If your Part D plan covers disposable insulin patch pumps, the pump is considered an insulin supply. It isn’t subject to the $35 cap, potentially costing more.

3. Special Enrollment Opportunities: Responding to Change

If your Medicare beneficiary uses a covered insulin product and decides they would like to be in a different Part D plan for 2023, they might qualify for a Special Enrollment Period (SEP) for Exceptional Circumstances. If they qualify for an SEP, they can add, drop, or change their Part D coverage one time between now and December 31, 2023. Assist your clients with coverage options that best meets their diabetic and other health needs by comparing costs and benefits, while ensuring they will have their current doctors available on their new plan, should they decide to change.

4. Medicare Part B and Durable Medical Equipment Benefit: Capped Insulin Costs

Effective July 1, 2023, additional relief was provided for those using insulin pumps covered under Medicare Part B’s durable medical equipment benefit or receiving covered insulin through a Medicare Advantage Plan:

  • Insulin costs are capped at $35 for a one-month supply.
  • Part B deductible doesn’t apply.
  • If you have Part B and Medigap covering Part B coinsurance, your Medigap plan should cover the $35 (or less) cost for insulin.

Empowerment through Information: Your Role as a Medicare Agent

These updates are pivotal for the well-being of Medicare beneficiaries managing diabetes. As a Medicare agent, you play a crucial role in ensuring they are informed and take advantage of available benefits. Reach out to beneficiaries, provide clarity on these updates, and offer guidance on navigating the changing landscape of diabetes management.

For more information on resources that will help you find the best coverage for your Medicare Beneficiaries, contact our Client Support Services today at 844-998-7878.

Remember, your dedication matters, especially during Diabetes Awareness Month. Together, let’s empower beneficiaries to take control of their health and embrace the available resources for a brighter and healthier future.

Trusted American Insurance Agency is a National Marketing Organization (NMO) headquartered in Roseville, CA. Trusted American provides a full range of insurance and financial services products across all 50 states for all major and niche carriers, with a specialty in the Senior Marketplace.

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