I turn 65 in January. I am presently on Omnipod. However, it looks like since it is a part D benefit it would cost me significantly more than the T slim which is covered under part B. Does that seem right?
This can definitely be confusing as insulin can be covered in one of two (really three) ways. If your care requires an insulin pump, this could be considered durable medical equipment. Durable medical equipment is covered under Part B. You would pay 20% of the cost. If you purchased a Medicare Supplement Plan, you might actually have no cost! If your care does not require an insulin pump then you would have to get coverage under Part D (or a Medicare Advantage Plan if you so choose). There are insulin savings plans that offer a month's coverage for $35. Please feel free to call us to discuss and we can point in the right direction to ensure you can get your insulin covered at the lowest cost to you. You can reach us at 888-410-0344. Also feel free to email us at support@ihealthbrokers.com.
Are all insulins covered at $35 per month? Examples would be Lantus vs. Tresiba long acting insulins. Some have said that President Biden has stopped the max payment of $35 for insulin. Please clarify. Thanks.
Hi Elaine, that's a great question. You can check out the full list here: innovation.cms.gov/media/document/partd-seniorsav-ndclist-2022. Because of your question, I'll also post it in the description below.
As long as you have creditable prescription drug coverage (not COBRA), you do not need Part D. Once you retire and no longer have that coverage, you can enroll without penalty.
Hi James! Insulin administered via pump should actually be covered under Medicare Part B (which is part of Original Medicare). You may still want Part D for other prescription drug needs, but your insulin should already by covered under Part B. You may also want to look into a supplement plan to cut down on the coinsurance. Let us know if there's anything else we can help with!
@@iHealthBrokers Coverage under part B is true for tubed pumps, but not tubeless, such as Omnipod. They are covered under Part D. Due to the expense, it may be prudent to purchase Novolog Relion insulin (prescription required) 10ML bottle at $73 out-of-pocket at Walmart, especially if you are not insulin resistant such as a Type 1 or Type 1.5 (the 5% 0f diabetics). The expense alone of the pump system like Omnipod 5 could take you into the donut hole on part D if you pile other drug expenses on top. Part B can still cover the Dexcom CGM even though the pump is on Part D.
@@chuckharrel8272 That is really excellent advice and a very insightful comment. Thank you for your feedback. Hopefully this will catch the eye of someone who can be helped by your advice!
Medicaid is a federal program, but certain states offer better benefits than others. As brokers, we cannot really assist your with Medicaid, so unfortunately, your best recourse is to contact medicaid directly with any questions.
The main problem with Med Advantage and beneficiaries, is most seniors don’t save the 6,700 out of pocket max in a savings incase of an emergency. So when something does happen, it puts them in a financial burden. If “John” gets sick in December 2021 he has to pay 6,700.00, if he is still sick in January 2022 he has to pay another 6,700.00. Some seniors file bankruptcy over this. Don’t let agents push you into something that doesnt meet your needs.
You are absolutely right. We warn people about some of the pitfalls of Medicare Advantage Plans in some of our other videos. Very often Part C plans sound too good to be true (and often they are). Most people end up with a Medicare Supplement Plan instead. However, for some people a Part C plan can be a great option. If depends on needs, budget, and location. Thank you for your insightful comment!
The ONLY reason to get a Medicare Advantage plan is because you absolutely can't afford the premiums for regular Medicare. The downsides of Medicare Advantage are many - you're at the mercy of an insurance company that's trying mainly to save money, you're restricted to a small network of providers, and you need to get prior authorizations for pretty much everything.
There are definitely many drawbacks to Medicare Advantage when compared to a Medicare Supplement. However in some places (and for some people) they can work wonderfully. But you are absolutely correct in that you will have a much smaller network and need referrals.
Video hardly discussed diabetes with reference to Medicare. Most of video was a basic discussion of Medicare plans in general and referring to other videos. Too much dead air.
Hi Rich, what questions do you still have? This video discusses different options for Medicare coverage and care for those with Diabetes. We talk about what Medicare Part B will cover for those with Diabetes as well as different options for Medicare Advantage and Part D to ensure people who take insulin can take advantage of the insulin savings model. We also talk about DSNPs, the Extra Help Program and Medicare Savings Programs to cut costs for those with Diabetes. We're always looking for suggestions from our viewers for new topics, so please let us know and we'll happy to add your topic to our list!
@@iHealthBrokers Labs, they are not covering labs? I'm getting bills for lab work that the doctor ordered for Diabetes, just normal Diabetes, no other complications, should I say routine labs?
I turn 65 in January. I am presently on Omnipod. However, it looks like since it is a part D benefit it would cost me significantly more than the T slim which is covered under part B. Does that seem right?
This can definitely be confusing as insulin can be covered in one of two (really three) ways. If your care requires an insulin pump, this could be considered durable medical equipment. Durable medical equipment is covered under Part B. You would pay 20% of the cost. If you purchased a Medicare Supplement Plan, you might actually have no cost! If your care does not require an insulin pump then you would have to get coverage under Part D (or a Medicare Advantage Plan if you so choose). There are insulin savings plans that offer a month's coverage for $35. Please feel free to call us to discuss and we can point in the right direction to ensure you can get your insulin covered at the lowest cost to you. You can reach us at 888-410-0344. Also feel free to email us at support@ihealthbrokers.com.
Nice video, I have Freestyle Libre sensor and Ambrosia NightRider for manage my glucose values. Both products are very helpful for me.
Thank you for sharing! Hopefully that will help someone else in need!
NightRider always helpful and far better than MiaoMiao and Bubble. It works a lot better .
Thank you so much for the information that I was looking forward for my mother.
Glad to be of help! Things have actually changed (for the better) since this video was posted as well!
Does medicare cover Dexcom none stick products
If you meet the criteria, then yes! www.dexcom.com/faqs/medicare Thanks for your question!
Are all insulins covered at $35 per month? Examples would be Lantus vs. Tresiba long acting insulins. Some have said that President Biden has stopped the max payment of $35 for insulin. Please clarify. Thanks.
Hi Elaine, that's a great question. You can check out the full list here: innovation.cms.gov/media/document/partd-seniorsav-ndclist-2022. Because of your question, I'll also post it in the description below.
Thanks for the info. Love Your clear voice!
Glad to be of help!
so what about if you have employer insurance with drug coverage do you still need to get part D?
As long as you have creditable prescription drug coverage (not COBRA), you do not need Part D. Once you retire and no longer have that coverage, you can enroll without penalty.
I am so interested in the covered insulin costs because I have a pump. Why would I need a part D if this is the case?
Hi James! Insulin administered via pump should actually be covered under Medicare Part B (which is part of Original Medicare). You may still want Part D for other prescription drug needs, but your insulin should already by covered under Part B. You may also want to look into a supplement plan to cut down on the coinsurance. Let us know if there's anything else we can help with!
@@iHealthBrokers Thanks for this information, much appreciated.
@@jamesbolasky9253 Glad we could help!
@@iHealthBrokers Coverage under part B is true for tubed pumps, but not tubeless, such as Omnipod. They are covered under Part D. Due to the expense, it may be prudent to purchase Novolog Relion insulin (prescription required) 10ML bottle at $73 out-of-pocket at Walmart, especially if you are not insulin resistant such as a Type 1 or Type 1.5 (the 5% 0f diabetics). The expense alone of the pump system like Omnipod 5 could take you into the donut hole on part D if you pile other drug expenses on top. Part B can still cover the Dexcom CGM even though the pump is on Part D.
@@chuckharrel8272 That is really excellent advice and a very insightful comment. Thank you for your feedback. Hopefully this will catch the eye of someone who can be helped by your advice!
What if I only have medicade
Medicaid is a federal program, but certain states offer better benefits than others. As brokers, we cannot really assist your with Medicaid, so unfortunately, your best recourse is to contact medicaid directly with any questions.
The main problem with Med Advantage and beneficiaries, is most seniors don’t save the 6,700 out of pocket max in a savings incase of an emergency. So when something does happen, it puts them in a financial burden. If “John” gets sick in December 2021 he has to pay 6,700.00, if he is still sick in January 2022 he has to pay another 6,700.00. Some seniors file bankruptcy over this. Don’t let agents push you into something that doesnt meet your needs.
You are absolutely right. We warn people about some of the pitfalls of Medicare Advantage Plans in some of our other videos. Very often Part C plans sound too good to be true (and often they are). Most people end up with a Medicare Supplement Plan instead. However, for some people a Part C plan can be a great option. If depends on needs, budget, and location. Thank you for your insightful comment!
The ONLY reason to get a Medicare Advantage plan is because you absolutely can't afford the premiums for regular Medicare. The downsides of Medicare Advantage are many - you're at the mercy of an insurance company that's trying mainly to save money, you're restricted to a small network of providers, and you need to get prior authorizations for pretty much everything.
There are definitely many drawbacks to Medicare Advantage when compared to a Medicare Supplement. However in some places (and for some people) they can work wonderfully. But you are absolutely correct in that you will have a much smaller network and need referrals.
@CatLady All plan Gs are guaranteed issue plans and their rate increases are the highest of any medical plan.
Video hardly discussed diabetes with reference to Medicare. Most of video was a basic discussion of Medicare plans in general and referring to other videos. Too much dead air.
Hi Rich, what questions do you still have? This video discusses different options for Medicare coverage and care for those with Diabetes. We talk about what Medicare Part B will cover for those with Diabetes as well as different options for Medicare Advantage and Part D to ensure people who take insulin can take advantage of the insulin savings model. We also talk about DSNPs, the Extra Help Program and Medicare Savings Programs to cut costs for those with Diabetes. We're always looking for suggestions from our viewers for new topics, so please let us know and we'll happy to add your topic to our list!
@@iHealthBrokers Labs, they are not covering labs? I'm getting bills for lab work that the doctor ordered for Diabetes, just normal Diabetes, no other complications, should I say routine labs?
@@testos2701 Is this Medicare Advantage? Are the labs themselves in network?
This basically tell me nothing!
Sorry you feel that way.