Medicare and insulin dependent diabetes

I know this is a much discussed topic, but it would be really great if type 1s in whatever state you live in could get together and discuss medicare options. I live in Massachusetts. I signed up for a medicare advantage plan. It’s okay. I may switch to Part D, but I only have 5 days to do so.

I found out that insulin syringes aren’t covered by my MA plan. Doctor has to write a letter about durable medical equipment, or you have to use a certain brand that you buy at a preferred pharmacy for cheap. I wrote to my doctor to see if this will work for me. then I just found out you can get insulin needles at walmart for like $12 a month without a prescription.

I called my MA plan, and asked about the supposed $35 cap on insulin (the Biden package that passed). They said it wouldn’t apply to their Tier 3 drugs, Humalog, Lantus. The price she quoted me was $47, which isn’t bad, but first I have to meet the $250 deductible.

There’s a drug plan that offers insulin at like 0 dollars, but you have to pay $55 a month for it, and it’s part D, and so if you see eye guys or diabetes guys or foot guys, then you have to pay 20% of whatever the cost is. I will probably have to call and find out how much these visits cost.

It would be helpful to hear what plans other people have gone for, what they are happy with and what they aren’t. My insurance SHINE counselor thought syringes were covered under Part B, but it’s only covered by a durable equipment letter.

I feel like I keep beating a dead hors, but I’d love to hear your experiences with medicare.

I am not from Mass. But I have heard a lot of people complain about advantage plans being a type 1. They sound great up front and I’m sure they work for a lot of people if they cover the items or what you want, but the problem seems to be they don’t a lot of the time. Or the doctors choice ends up very limited. You might get the gym membership, meals, cheaper or no copay, but you don’t get the insulin brand you want. The costs for some things gets taken away other things.

But original medicare has costs too, unless you get a supplemental or some people get a gap insurance and those add on cost also. But the benefits of supplemental’s are more doctors are covered and more scripts are covered and they offset the charges from Medicare.

My supplemental to Medicare has been great, but we get it through my husbands past employer. I gather there are Medicare information lines? Someone here probably has that information.

I’m just not sure how many type 1’s or insulin users from Mass on Medicare in 5 days that will see this right now?

A warning, 20% of costs of doctors could really add up. Some of the specialists charge $250-400 just to say hi to you.

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I am in MA and have BCBS bronze which covers me worldwide and covers all my medical costs except for my insulin. No 20% deductible for anything. No worry about in or out of network doctors, don’t even need referrals. I looked at All the advantage plans and they sound great, but when you dig into them find they are not good plans for creative diabetics. I am MDI, and have a cheap part D plan and then buy my insulin by mail from Canada. My insulin cost is just a small fraction of what it would be on an advantage plan including premiums, donut hole, etc.

I’m not eligible for that one, but thank you for posting!

Ame

Yes that is true. And if they send you to a specialist to consult there goes another 20% For me flat fees tend to work better.