Prepare for Health and Medication Questions About Diabetes
Diabetes affects more than 25 percent of Americans aged 65 or older. Its prevalence is projected to increase approximately two-fold for all U.S. adults (ages 18-79) by 2050 if current trends continue. Medicare spent an estimated $1,500 more on Part D prescription drugs, $3,100 more for hospital and facility services, and $2,700 more in physician and other clinical services for those with diabetes than those without diabetes.
Example: Insulin – How often is it covered?
Medicare Part B (Medical Insurance) doesn’t cover these:
- Insulin (unless use of an insulin pump is medically necessary)
- Insulin pens
- Alcohol swabs
Medicare prescription drug coverage (Part D) may cover these:
- Certain medical supplies used to inject insulin, like syringes, gauze, and alcohol swabs
If you use an external insulin pump, insulin and the pump may be covered as durable medical equipment (dme) (DME).
Why is This Important?
Since 1 in 4 of your clients are statistically going to have diabetes, AEP reviews of health and drug coverage are sure to generate questions. Many of those will include questions about insulin and diabetic supplies. The links below are invaluable resources to verify Medicare coverage for specific questions.
- CMS Medicare Learning Network- Coverage Overview – https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE0738.pdf
- Medicare.gov: Diabetes Supplies and Services – https://www.medicare.gov/coverage/diabetes-supplies-services
Restoration of the Medicare Advantage Open Enrollment Period
The 21st Century Cures Act eliminates the existing MA disenrollment period that currently takes place from January 1st through February 14th of every year and, effective for 2019, replaces it with a new Medicare Advantage open enrollment period (OEP) that will take place from January 1st through March 31st annually.
The new OEP allows individuals enrolled in an MA plan, including newly MA-eligible individuals, to make a one-time election or to go to another MA plan or Original Medicare. Individuals using the OEP to make a change may make a coordinating change to add or drop Part D coverage.
- MA-Only to MA-Only
- MA-Only to MA-PD
- MA-PD to MA-Only
- MA-PD to MA-PD
- MA-Only or MA-PD to Original Medicare without PDP
- MA-Only or MA-PD to Original Medicare with PDP
- Switching between Plan benefit packages (PBP’s) of one organization
- Beneficiaries in original Medicare and Cost plans cannot use the new OEP, regardless of Part D coverage. Also enrollment into a cost plan during OEP is not allowed.
Why is this Important?
Agents need to be aware that a client essentially has a three month “free look” at their plan and should be making sure that their providers and drug lists are carefully reviewed to avoid the client leaving their plan.