For the 33% of Medicare Beneficiaries with diabetes, the price of insulin can cause stress and uncertainty. Not only is the price tag of insulin high, but it can also change up to 4 times a year depending on which stage of coverage they are in.

Earlier this year, the Centers for Medicare & Medicaid Services (CMS) revealed a new plan to make these prices more consistent and predictable. Under the new Part D Senior Savings Model, insulin will cost a flat rate of $35 for a month’s supply, no matter what coverage stage of Part D you are in.

How Does it Work?

With current Part D guidelines, clients in the Coverage Gap are expected to pay for 25% of the drug price. Under the new Part D Senior Savings Model, insulin prices are capped at $35 for the client, with insurance and the drug manufacturer responsible for the rest. Below is a quick cost comparison:

So, what’s the catch?

The Senior Savings Model only applies to Enhanced Part D plans. These plans have higher premiums than basic Part D plans, but they also offer extra supplemental benefits, provide additional coverage in the donut hole, and some are even deductible free. It’s due to the higher premiums paid on these plans that the Insurance companies can cover the remaining costs of Insulin under the new model.

However, in most cases, the savings of this plan outweigh the higher premiums. CMS estimates that a beneficiary enrolled in a participating plan will save an average of $446 in annual out of pocket costs on insulin. That’s the same amount in savings as the standard deductible.

How do I Sign Up?

Not every Enhanced plan is using the new model, but there are 1,750 individual plans participating and you can find them in all 50 states.

In order for the new plan to take effect on January 1st, 2021, you must switch your coverage during the Annual Enrollment Period, which is October 15 through Dec. 7 of 2020. 

We understand that Part D has many moving parts, but Senior Benefit Services (SBS) can help you navigate and understand the drug coverage options that are right for you. Call us with any questions and to help you find possible savings. 


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