Insurance company providers offer special needs plans under the umbrella of Medicare Advantage Plans (MAPD). Special Needs Plans, also known as SNPS, provide coverage to people with specific diseases such as Cardiovascular disease or certain lung disorders to name a few. Participation in a SNPs is limited to those meeting specific eligibility requirements. First, a candidate must have Medicare Parts A and B insurance. Second, candidate must have a chronic condition such as those listed above or on the medicare.gov website. Insurance companies decide where they will offer these plans. They may be available in different parts of the country or even different parts of a state. Certain counties or even cities within a state may offer different types of SNPs and some cities or counties may not offer any SNPs at all.
The advantage to having a Medicare Advantage Special Needs Plan is that these plans customize the benefits, providers and prescription drug formularies to best fit the needs of the specific illness it is designed to cater to. Most SNPS are HMO plans, require prescription drug coverage and selection of an in network primary care physician. Some carriers may also require a care coordinator to help with your health care.
Diabetes is considered a chronic illness and eligible for a SNP. This illness occurs when the body is unable to produce insulin which is the hormone that regulates blood sugar levels. When the body is not able to produce enough insulin, sugar is not able to get into the cells and the individual’s blood sugar levels may rise which can lead to other health problems. The Centers for Disease Control and Prevention (CDC) estimates that 34 million people in the United States has diabetes. Furthermore, according to medicare.gov, 1 in 3 people with Medicare has diabetes compared with other SNP qualifying illnesses.
Due to the imbalance of insulin in the body, many diabetics are required to take insulin. This medication is usually fairly expensive even with Medicare Advantage SNP cost sharing. However, Medicare beneficiaries, and especially diabetics taking insulin, have much to look forward to with Medicare changes in 2021 health care plans. Many premiums have been lowered. As a matter of fact, we have seen plan premiums drop an average of 34%-60% across the nation in the last 3 years, according to medicare.gov. The decline in benefit costs include a drop in insulin prices. Roughly 1600 participating drug plans are offering a month’s supply of insulin for $35 or less starting January 2021. Cost changes will vary between MAPD plans and some carriers may only offer the decrease in their Prescription Drug Plans, as opposed to the Medicare Advantage Prescription Drug Plan.
To find out if you qualify for a plan that offers the discounted insulin costs, contact Centsable Dollar to search available plans in your area. Open Enrollment ends December 7th. So make sure to call 602.644.1240 (TTY: 711) or email info@centsabledollar.com today.
Resources for managing diabetes:
