Medicare has excluded insulin from many insurance plans: how not to be left without medication

With Medicare's annual open enrollment period ending on December 7, Medicare experts have found that many health plans are eliminating some types of insulin in 2024. What does this mean for consumers? USA Today.

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In an informal survey of 65 Medicare plans, 22 plans excluded at least one insulin, according to Diana Omdahl, founder of 10 Inc., which provides Medicare enrollment counseling. Four plans are eliminating four or more different insulins, she said.

If you're hoping to save $35 on insulin next year, check to see if insulin is covered by your plan. Only if your drug plan covers insulin will you receive the $35 limit, according to the Centers for Medicare and Medicaid Services.

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“Plans may not cover drugs, and that's what happens,” Omdahl says. “People will have a hard time if they find out that their insulin is not covered and is not included in the limit.”

Why insurance companies refuse to cover insulin

According to experts, this may be due to changes made by the administration of US President Joe Biden to the Medicare program.

Because of the insulin cap, "we're seeing some insurance companies respond to this change by adjusting the drugs they cover," said Dr. Carla Robinson, medical editor at drug price comparison site GoodRx. “Some insurance companies choose not to cover insulins that have higher manufacturing costs or face manufacturing problems.”

In addition to the insulin cap, cost sharing will be waived next year once enrollees reach the catastrophic coverage level or when out-of-pocket costs reach $8000. In 2023, beneficiaries paid 5 percent coinsurance or copayments in some cases at catastrophic levels.

In 2025, out-of-pocket drug spending will be capped at $2.

While Medicare beneficiaries will save thousands, insurance companies will pay more and are likely to look for new ways to shift costs and make more profits, experts say.

What should people do?

People should check their Medicare plans now to see if their insulin is covered, Omdahl said. If not, they need to talk to their doctors to find an alternative that may be covered by their plan or enroll in a different insurance plan.

And all this must be done before December 7, the last day to enroll in Medicare each year.

“If you have Medicare Part D, then this plan is with you for the whole year,” Omdahl said. “Your window closes on December 7.”

However, Medicare Advantage members can still change their plans during the open enrollment period from January 1 to March 31.

People should go to Medicare.gov, enter all the drugs they take, and see if their plan will cover those drugs next year. They can also look at other plans they are eligible for. They can then compare coverage and prices before choosing a plan.

With the deadline so close, experts recommend avoiding calling Medicare if possible; you could be stuck on hold for hours.

If you need help, contact health insurance assistance programs or Medicare brokers vetted by the National Council on Aging to advocate for older adults.

Special warning for users of insulin Levemir

If you use Levemir insulin, you should know that the manufacturer, Novo Nordisk, has announced that it will discontinue this insulin in 2024. Shortages could start as early as January, so you should start looking for an alternative that is covered by your insurance plan, Omdahl said.

How much will insulin cost if you don't have insurance?

It could cost hundreds of dollars more per year and be a "catastrophe" for more than a million Americans, a Yale University study published last year found.

Among Americans using insulin, 14,1% reached catastrophic costs in one year, the study found. Catastrophic spending refers to more than 40% of income spent on insulin after paying for food and housing.

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Nearly two-thirds of the patients who faced this level of insulin costs were Medicare beneficiaries, the study found.

If you're in a plan that doesn't cover insulin, you may still have options.

You can talk to your doctor to see if another type of insulin that is covered by your plan is right for you.

“You can also check for patient assistance programs or other discounts,” says GoodRx's Robinson.

For example, GoodRx can help you find savings on diabetes medications, including insulin, she said. Through the partnership with Sanofi, eligible patients can use GoodRx to receive a $35 coupon for a 30-day supply of Lantus, which is available at 70 retail pharmacies, she said.

How many Americans on Medicare take insulin?

The number of Medicare Part D beneficiaries taking insulin in 2020 was 3,3 million, according to the health research nonprofit KFF.

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