What if my Medicare Part D plan doesn’t cover my insulin?
Dear Toni: In 2022, I enrolled in Medicare with a supplement and a Part D plan that included my prescriptions that had copay only. But I recently noticed that the diabetic insulin I take will no longer be covered in 2025. This change will cost $391 monthly out of pocket. And Ozempic, which has an $11 copay in 2024, is a tier 5 drug costing $238 per month with no copay for 2025.
With Ozempic and the meds I take monthly, I will meet the $2,000 out-of-pocket maximum in February, paying $0 the rest of the year — except for the $391 for the insulin each month.
Toni, how can I find a 2025 Part D plan that covers my insulin and change before the annual enrollment period ends Dec. 7? — Tabitha, Lubbock, Texas
Dear Tabitha: Many Americans who take brand-name drugs such as Ozempic or Mounjaro or diabetic insulins are seeing the costs increase or no longer being covered. This problem is also occurring with Medicare Advantage plans.
Changing to a Medicare Part D plan or a Medicare Advantage plan with Part D is an easy process:
■ Log in to your medicare.gov account and click on “Find health and drug plans.”
■ Verify your “Extra help” (based on income), list the pharmacies you prefer; under “Your drug list,” list all of your prescriptions. Enter them into the system on a monthly basis rather than a three- or six-month basis, because of Medicare’s new $2,000 out-of-pocket maximum. This lets you know when you will reach the out-of-pocket limit and no longer have to pay the deductible or copay.
■ Click on “Find plan now” and “2025” to find 2025 Part D or Medicare Advantage plans.
■ Select which plan you wish to enroll in by checking either Medicare Advantage or Medicare Part D (stand-alone).
■ Your current enrolled plan will show up first with the 2025 premium. The plans listed after the plan you are enrolled in are rated from the least out of pocket to the most.
■ Search through the prescription drug plans below the current one to find which Part D plan covers your insulin and your other prescriptions at the lowest copay.
■ Take your time exploring options and selecting the plan that meets your prescription and financial needs.
■ In the drug plans you are exploring, under the section titled “Estimated total monthly drug cost” it will show when you would meet the $2,000 out-of-pocket drug cost.
Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.
