Part D Senior Savings Model
The Part D Senior Savings Model offers an affordable monthly $35 copay for insulin in the deductible, initial coverage and coverage gap phases of the Part D benefit. Most Medicare Advantage (Part C) and Part D plans are participating in the model in 2023. Our guide breaks down the benefits of the Senior Savings Model, including information on how much you can save on insulin, what’s covered and how to sign up.
- Written by Lindsey Crossmier
Lindsey Crossmier is an accomplished writer with experience working for The Florida Review and Bookstar PR. As a financial writer, she covers Medicare, life insurance and dental insurance topics for RetireGuide. Research-based data drives her work.Read More
- Edited ByLamia Chowdhury
Lamia Chowdhury is a financial content editor for RetireGuide and has over three years of marketing experience in the finance industry. She has written copy for both digital and print pieces ranging from blogs, radio scripts and search ads to billboards, brochures, mailers and more.Read More
- Reviewed ByChristian Worstell
Christian Worstell is a licensed health insurance agent and an established writer in the sector, with articles featured in Forbes, MarketWatch, WebMD and more. His work has positively impacted beneficiaries nationwide and empowers them to make strong health care decisions.Read More
- Published: January 13, 2023
- Updated: January 17, 2023
- 5 min read time
- This page features 6 Cited Research Articles
- Edited By
- The Part D Senior Savings Model sets a limit of $35 for a one-month supply of insulin, which applies in the deductible, initial coverage and coverage gap phases.
- The Model is expected to save Medicare beneficiaries an average of $446 in annual out-of-pocket costs on insulin.
- Most Medicare Advantage (Part C) plans and Part D plans are participating in the Part D Senior Savings Model.
- Select pharmaceutical manufacturers will pay the 70% discount in the coverage gap for their Part D insulin.
- The Part D Savings Model began on Jan. 1, 2021 and has participating plans in all 50 states, D.C. and Puerto Rico until 2025.
What is the Part D Senior Savings Model?
The Part D Senior Savings Model is a voluntary model intended to reduce insulin costs and increase coverage for select Medicare Advantage and Part D plans. The voluntary Model began on Jan. 1, 2021, and will continue for five years, through Dec. 31, 2025. The Part D Savings Model is participating in plans in all 50 states, D.C. and Puerto Rico in 2023.
The Centers for Medicare & Medicaid Services (CMS) projects that the Part D Senior Savings Model will provide savings to over 800,000 beneficiaries who use insulin. Each beneficiary is predicted to save an average of $446 in annual out-of-pocket costs on insulin.
The Senior Savings Model has proven to bring more affordable drug coverage to millions of beneficiaries. Anyone enrolling in a Medicare Advantage or Part D plan should strongly consider a policy that participates in the model.
How Does the Part D Senior Savings Model Work?
The Part D Senior Savings Model sets a limit of $35 for a one-month supply of insulin in three out of the four phases of Part D Coverage. The only phase that doesn’t change cost sharing by the Senior Savings Model is the catastrophic phase.
|Part 1: Deductible||✓|
|Part 2: Initial Phase||✓|
|Part 3: Coverage Gap||✓|
|Part 4: Catastrophic Coverage||✗|
The $35 insulin limit applies at all pharmacy types, preferred and nonpreferred, even if you order from an in-person pharmacy or online.
There are specific manufacturers participating in the Part D Senior Savings Model that are covering select insulin dosages. There are three insulin types available — rapid-acting, intermediate-acting and long-acting. Refer to CMS’s 2023 Part D Senior Savings Model National Drug Code list to see what drugs are covered.
- Eli Lilly and Company
- MannKind Corporation
- Mylan Specialty L.P.
- Novo Nordisk, Inc. and Novo Nordisk Pharma, Inc.
- Sanofi-Aventis U.S. LLC
Which Plans Are Eligible for the Part D Senior Savings Model?
Select Medicare Advantage and Part D plans are eligible for the Part D Senior Savings Model, but it isn’t a requirement for all plans. Insurers apply to participate in the Model.
In 2022, there are 2,159 Medicare Advantage and Part D plans participating in the Part D Senior Savings Model. CMS projects over 2,500 prescription drug plans to participate in the Model in 2023.
How To Apply for the Part D Senior Savings Model
You can apply for the Part D Senior Savings Model by signing up for a Medicare Advantage plan or a Part D plan during open enrollment. Make sure that your plan is participating in the Model before enrolling.
According to CMS, the new $35 cap may not be reflected when you compare 2023 plans on their website. CMS recommends connecting with one of their agents if you’re not certain which plan is participating in the Model.
To get a better understanding of which plans are participating in the Part D Senior Savings Model near you, refer to CMS’s 2023 Part D Senior Savings Model Landscape File.
Other Ways To Save On Insulin
You can also consider applying for the Extra Help Program or reach out to the American Diabetes Association to save on insulin. Extra Help is a federal program that can save you roughly $5,100 per year.
The American Diabetes Association is a nonprofit charity that provides ample resources and aid to those struggling to pay for their insulin. They advertise three main insulin manufacturers who offer immediate assistance and long-term resources.
If any of the manufacturers below supplies you with your insulin, contact them to learn about your savings options.
|Lilly Diabetes Solution Center||833-808-1234|
|Novo Nordisk NovoCare||1-844-668-6463|
|Sanofi Patient Savings Programs||1-855-984-6302|
Frequently Asked Questions About the Part D Senior Savings Model
Editor Samantha Connell contributed to this article.
6 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2022, November 16). Part D Senior Savings Model. Retrieved from https://innovation.cms.gov/innovation-models/part-d-savings-model
- Aubrey, A., & Inskeep, S. (2022, September 12). Insulin Costs Increased 600% Over the Last 20 Years. States Aim To Curb the Price. Retrieved from https://www.npr.org/2022/09/12/1122311443/insulin-costs-increased-600-over-the-last-20-years-states-aim-to-curb-the-price
- Social Security Administration. (2022). Extra Help With Medicare Prescription Drug Plan Costs. Retrieved from https://www.ssa.gov/benefits/medicare/prescriptionhelp.html
- U.S. Centers for Medicare & Medicaid Services. (2022). Insulin. Retrieved from https://www.medicare.gov/coverage/insulin?utm_source=google&utm_medium=paid_search&utm_campaign=pn-cmsoe-insulin-2022-gm&utm_term=trafficdriving&utm_content=pn-10152022_insulin_rsa1
- U.S. Centers for Medicare & Medicaid Services. (2020, March 11). Part D Senior Savings Model. Retrieved from https://www.cms.gov/newsroom/fact-sheets/part-d-senior-savings-model
- American Diabetes Association. (n.d.). Insulin Help. Retrieved from https://insulinhelp.org/
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