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Insulin Price Increase and Impacts on Beneficiaries

By  Senior Market Advisors  on January 28, 2019

According to the American Diabetes Association, half of Americans over the age of 60 have diabetes. Insulin prices have continued to rise, and many Medicare beneficiaries struggle to pay for their out-of-pocket costs. It’s important to understand the price increases so you can inform beneficiaries of the benefits of Part D and ultimately make a sale.

Insulin Price Increase

The average diabetes patient spent $2,864 on insulin in 2012, but this increased to $5,705 by 2016. This means a typical insulin user went from a $7.80/day expense to $15/day. This can create a significant burden on beneficiaries because insulin is, on average, only 30% of all diabetes-related health costs.

This spike increase has attracted several media sources and lawmakers, but insulin prices have continued to increase an additional 9% since 2016. This issue is still being addressed, and there are several people pushing for this increase to stop. It’s important to understand what Medicare and Part D covers so you can help beneficiaries get the coverage they need.

Medicare Insulin Coverage vs. Part D

Original Medicare Part B covers:

  • Blood glucose test strips
  • Blood glucose monitors
  • Glucose control for checking test accuracy
  • Therapeutic shoes or inserts
  • Insulin*

*Medicare Part B will only cover insulin that is needed for an external insulin pump and may be covered as Durable Medical Equipment.

Original Medicare Part B does not cover:

  • Other forms of insulin
  • Pens, syringes, or needles

Medicare Part D covers:

  • Insulin (unless it is used through an external pump)
  • Associated diabetes drugs
  • Pens, syringes, or needles
  • Swabs and gauze
  • Inhaled insulin devices

Medicare Part D does not cover:

  • Insulin through an external pump

Other Benefits of Part D

When you are selling Part D plans to beneficiaries, be sure to mention the other benefits of a Part D plan. Some key benefits to discuss include:

  • Drug coverage that Original Medicare does not cover
  • Different drug formularies to ensure their drugs are covered
  • $415 deductible for 2019
  • The Part D donut hole is closing
  • Medicare Extra Help program (depending on eligibility)

Medicare Extra Help Program

The program is designed to help beneficiaries who do not qualify for Medicaid but still need financial assistance. Most eligible beneficiaries don’t even know that they are eligible for Extra Help. You can help your existing clients better afford their health care by helping them apply for Extra Help. If they qualify, they will receive for a continuous SEP. You can use their SEP to make sure they have a Part D plan. To learn how to set up events to find Medicare-eligibles who qualify for Extra Help, click here.

Benefits of Senior Market Advisors

At Senior Market Advisors, we make sure our agents are equipped with the best tools so you can make the best sells. We have a custom lead management system that helps you manage your growing book of business and have a custom Medicare quote engine that makes sure you are providing accurate and streamlined quotes. Plus, our relationships with the major carriers make sure you receive the top tier commissions you deserve. Ready to contract? Visit or fill out this form.