Medicare open enrollment brings more options, capped insulin prices and expanded telehealth

It’s been a tough year to be sure. But amidst a pandemic that continue to raise our stress levels, here’s some good news for most senior citizens as Medicare open enrollment begins Oct. 15. CMS reports there will be many more Medicare Advantage (Part C) plans offered for 2021, some with stable or decreased premium costs. There also will be some changes that foster the continued expansion of telehealth services such as those delivered by RxLive, along with capped prices for covered insulins, and new Medicare Advantage (MA) availability for people with end-stage renal disease (ESRD). Most are causes for celebration.

Many MA plans that include Part D prescription coverage — and this is also true for the “add-on” Part D plans to original Medicare — will include the new Part D Senior Savings Model. This is designed to offer what CMS calls “lower, stable and predictable out-of-pocket costs” for select insulin drugs. Patients will pay a maximum of $35 for a one-month supply of covered insulins through the deductible, initial coverage and coverage gap stages of their plan, and 5% of the cost of covered insulin in the catastrophic stage. Some people’s costs may be even less if they receive extra help from Medicare.

One variable as of this writing — Premiums for Part B, which all Medicare patients must pay monthly, were likely to face a somewhat significant jump above the average yearly adjustment. However, the short-term federal government funding bill capped the increase at no more than 25% of what it otherwise would have been for 2021. Uncertainty in finalizing the actuarial formula for next year is due to the higher costs of COVID-19-related care, partially offset by people delaying medical services due to concerns over the safety of visits to hospitals, doctor’s offices and clinics during the pandemic. It should end up being just a few dollars more than this year’s $144.60 standard monthly Part B premium.

Get ready, get set…

Again, the open-enrollment period for 2021 Medicare coverage starts Oct. 15 and goes through Dec. 7 (Pearl Harbor Day). So it’s the right time for Medicare patients to do their research and make a choice regarding which Medicare Advantage plan — or combination of original Medicare parts — seem best chosen considering your health needs and your pocketbook.

You may have already received a hard copy of the 2021 Medicare and You handbook in your mail; otherwise, a copy is here on the Medicare website. If you’re new to Medicare and haven’t already created a MyMedicare.com account (login), you can start a new one. Remember that if you’re approaching age 65, you must apply for Medicare Parts A and B three months before that birthday milestone. It’s easy to do at socialsecurity.gov/benefits/medicare.

An important note: As you do your plan evaluation, a reminder that any website which doesn’t end in .gov is not an approved government Medicare site and could be a site designed to promote a specific plan or group of plans. Government Medicare representatives will never call to solicit your business.

Once you have your MyMedicare account established, it’s easy to determine which plans are available based in your area and compare the details of those plans. You can evaluate them based on type (PPO, HMO, fee-for-service, etc.) as well as by premium, deductible, estimated yearly costs and other factors. Have your list of physicians and choice(s) of pharmacies on hand as well a current list of medications, strengths, doses and frequency on hand so you can make an educated choice.

Insulin savings now easy to find

There are more than 34 million Americans (over 10.5% of the population) with diabetes. It’s estimated at 14.3 million (or a much higher percentage, 26.8%) for American seniors. While not all are on insulin, the drug remains a widely used medication that has seen significant price increases in recent years. Some people have felt the financial need to skip or cut back on doses as they work to also cover costs for such necessities as food, utilities and shelter. We try to help.

Fortunately, this plight increasingly has come to the attention of the nation’s leaders. Now, as you evaluate Medicare plans for 2021, there’s a handy new “Insulin Savings” filter within the Medicare Plan Finder to display plans that offer capped out-of-pocket costs for insulin, often at no more than a $35 monthly copay.

Situations and plans change. Don’t just let it ride.

I say something like that every year. Don’t assume your current plan will be unchanged, or that your health needs haven’t changed since a year ago. And remember that if you don’t choose a plan, your current Medicare Advantage provider will do it for you…whether you like their choice for you or not.

The Medicare open-enrollment period is always a great time to examine any changes to your participating providers and your medication regime since you chose your current plan, and to closely evaluate the coverage offered under the equivalent of that plan for 2021. These factors could make a difference in whether you stick with your current plan or choose to switch to another plan that could be more suited to your needs now.

As noted, even your current 2020 plan is likely to change its deductibles and especially some of the plan’s prescription drug formularies (list of medications they cover) in perhaps costly ways. So as we say at RxLive, “It’s great to check your meds!™” and that’s part of what we do in a private, secure medication-management consult with each of our patients.

Choose wisely

As with any decision that affects your physical and financial health, it’s best to do your homework, seek insights from your physicians and folks like the clinical pharmacists of RxLive as you examine your medication regime and — with a nod to “Star Wars” — choose wisely, Obi Wan.

As always, let us know how we can help. Schedule a private, secure video chat or phone medication consult through this link or by calling 1-(866) 234-4974. We’d love to talk with you.

Author avatar
Kristen Engelen, PharmD
Kristen Engelen, PharmD, is the chief pharmacy officer of RxLive and a certified consultant pharmacist; she has over a decade of experience in retail pharmacy settings. Kristen became an RxLive co-founder because of her passion for geriatric pharmacy, with a focus on the intersection of pharmacy and aging.