Fred L. Goldenberg: Medicare 2025 starting to bloom

May 5—Over the last few weeks, I've been involved in several meetings, both in-person and online, regarding anticipated changes to Medicare and supplemental programs for 2025. As information is released, more questions are generated without adequate answers. But in some instances, I can feel confident that I can speak with certainty.

As I learn more, I will be providing you with additional information that will help you make an informed decision when we finally reach the Annual Enrollment Period in October, and you sit down to review your plan for the next year.

Today's column focus on a true American epidemic: diabetes. According to the American Diabetes Association, 38.4 million Americans or 11.6% of the population, suffers from diabetes. Type 2 diabetes accounts for 90-95% of cases, with Type 1 accounting for 5-10%. One in five Medicare beneficiaries ages 65 or older have been diagnosed with either Type 1 or Type 2 diabetes.

So, it's no wonder the Inflation Reduction Act (IRA) of 2022 focused of diabetes as one of its first targets. The IRA attacked on several fronts. Some went into effect in 2023 and others will be phasing in over the next two years and beyond.

In 2023, one of the first real tangible effects of the IRA was that it ensures that people with Medicare pay no more than $35 for a month's supply for each covered insulin product under Medicare prescription drug coverage, Traditional Medicare or Medicare Advantage.

Unfortunately, these savings are not available to those individuals under 65 years of age. For those covered by employer-sponsored plans, the costs vary depending on your coverage, with co-pays and deductibles playing a significant role in your costs. For those without insurance, the cost can range from $400 to $700 a month, depending on insulin needed.

Actually, most of the benefits of the IRA are focused on seniors and Medicare with the exception of the expansion of the ACA subsidies and energy-related saving.

Another triumph for the IRA was Medicare's ability to negotiate pharmaceutical prices. Although, when you read the convoluted formula Congress worked out, it makes your head spin. Medicare is limited to 10 drugs initially. Those drug prices are currently being negotiated and we won't see any relief until 2026.

Of these 10, the majority are for treatment of diabetes. They include Jardiance, Xarelto, Januvia, Farxiga, Fiasp, Fiasp Flex Touch, NovoLog, NovoLog Flex Pen and NovoLog PenFill (these last five are grouped together). Over the last year Medicare has paid pharmaceutical companies and drug wholesalers more than $23 billion to provide these drugs to Medicare beneficiaries.

Not surprisingly, those companies filed suit to stop the IRA negotiations, but after meeting with President Biden, backed off and agreed to sit at the table like grownups.

Although these are positive steps in helping save millions of dollars for we seniors, one glaring hole in the IRA pertains to diabetic durable equipment.

Insulin is just a part of the equation. Diabetics must continuously monitor the insulin levels.

There are numerous ways to do this, with the most common a finger stick. Medicare covers 100% of testing supplies but doesn't cover monitoring equipment, or if you have Part D coverage, you most likely will be subject to co-pays and deductible. So, $35 per prescription is great, but if you want a continuous glucose monitoring system, you can expect to pay hundreds of dollars.

Overall, the IRA has and will provide much needed relief to those who suffer with diabetes.

Hopefully we will see prescription prices fall and added benefits for all who are affected by diabetes, no matter what age.

In addition to the above, the next major shift will be in the Medicare Part D Prescription Drug plans. One of my next columns will address the changes as we currently know and what you should expect. It's a biggy.

In the meantime, if you or someone you know is 64 or retiring this year, tell them about our free, educational, no sales Medicare 101 classes.

The next Medicare 101 class will be held on May 16. Two sessions: 10 a.m. and 6 p.m. at the Traverse Area District Library. Call 231-944-1400 to reserve your seat. Seating is limited.

Fred L. Goldenberg is a Certified Senior Advisor (CSA) working with Michigan Planners, a financial services and certified health insurance organization in Traverse City. Contact 231-944-1400 or [email protected] with any questions or comments about this column or with interest in monthly Medicare classes.

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