Under recently announced plans Seniors enrolled on medicare will be able to choose plans which limit co-pays for insulin.  President Trump endorses a deal designed to benefit a significant group of US citizens.

Who is eligible for this plan to cap insulin prices?

Anyone aged 65 or over and suffering from diabetes (types 1 or 2) and in particular anyone who will turn 65* before the end of March 2021.


Approximately 25% of seniors suffer from diabetes.  That is 14.3 million people. But not all of them are enrolled on Medicare.  Of those who are, it is estimated that six out of ten are already enrolled in a Medicare Advantage plan, or Medicare part ‘D’ which will cover the new benefit.

Check our article on: How to signup for Medicare at the age 65?

The cost of insulin is one of the greatest worries that sufferers of diabetes experience.  Over 30 million American citizens are affected. Most of them depend on insulin to maintain their blood sugars at normal levels and protect them from major complications, such as heart disease and kidney failure.

People suffering with diabetes are no more likely to be infected by COVID-19 than other groups but the evidence is, that they are more likely to suffer worse outcomes.

Read our article on: Do Medicare plans cover Coronavirus treatments & costs?

*If you are a member of a group plan (employer sponsored) you will be automatically enrolled into Medicare when you turn 65.  It will be YOUR responsibility to ensure that your new policies meet your specific needs.  In the first instance, contact your plan coordinator.

What can you expect in this plan to cap insulin prices?

Enrollees who opt for drug plans which offer the new insulin benefit would pay a maximum co-pay of $35 per month.  There may be a small increase in the monthly premium but the net saving is estimated to be worth between $400-$500 each year.

By opting for the new ‘supplemental insurance plans ‘beneficiaries will not only save money they will also have the security of a fixed budget and avoid the unpredictable fluctuations in drug prices.

At list prices, insulin treatment can cost as much as $5,000 per year. Although insured patients do not pay that much, they are exposed to co-pays which rise (inexorably) in line with rising list prices.  We are all aware of anecdotal evidence that individuals, unable to afford their prescribed doses of insulin, may try to get by with reducing their dosage; a dangerous and sometimes fatal choice!

When will the new benefit of the plan to cap insulin prices come into effect?

The new benefit comes into effect on January 1st 2021.  That seems a long way off, BUT you will need to make sure that your plan for 2021 will cover your needs in these new circumstances and that must be done during OPEN ENROLLMENT which begins November 1st 2020.  Now THAT, is not so far away.  Contact your exchange and review your options.

How to proceed?

You need to be certain that your provider is a participant in the program and that your specific insulin needs are covered – including pen and vial for the various formulations (rapid-acting, short-acting, intermediate-acting, and long-acting versions)

Remember, not all insurers are signed up for this scheme and not all plans will include your prescribed medication on their formulary.

According to Seema Verma, Head of Centers for Medicare and Medicaid Services, there are 1750 plans that offer prescription drug coverage to Medicare recipients and participate in the ‘enhanced’ plans providing supplemental (insulin) benefits.  Don’t leave it to chance!

Talk to your exchange, review your coverage.  You may find a change of metal band, say from silver to gold, will now give you better value for money.  You may also benefit from the peace of mind offered by a 5* rated provider.  Perhaps your savings could give you cover for Vision, Dental or possible future Medical expenses.

Make the most of this opportunity