MAPD and Diabetes

[kgmom219]

I have a client with T1 diabetes and the drug costs are going to devastate her in retirement. (Or she thinks it will. We are also doing an IRMAA appeal, so its not adding up.)

Are there any MAPD plans that offer "special help" with diabetes?

Planfinder isn't helping with regards to the cost of meds.

TIA!

 

[Chazm]

It’s all county specific. For instance, in central Florida I would pioint out Freedom. They cover insulin at a tier 1 before and during the gap.

Did you click the radio button with people with chronic conditions?

 

[midwestbroker]

Search Medicare.gov - When you get to step 4 of 4 (refine your plan results) on the left side of the site there are options to go more specific with the results. Click on the "+" next to Select Special Needs Plans" and choose plans for people with certain chronic or disabling conditions.

 

[kgmom219]

Thanks guys...and NO. I never even look at those, because I don't do these. I am not even sure I knew they existed.

You are both my favorites today! <3

 

[springbokhouston]

The Aetna plans normally work pretty well, but it really depends on the meds. If you need help in TX hit me up and I will be happy to help you find something.

 

[Ron Van D]

Humana has a special plan for "Diabetes and Heart".

 

[springbokhouston]

The Diabetes and Heart plan is not available in every state @Ron Van D , but it is a great plan that's for sure. We have agents in the Chicago area that do very well with it and the clients absolutely love it.

 

[Chazm]

And be careful, just because it’s a chronic plan, it doesn’t mean it’s better.

For instance, in FL Humana has a regular HMO that has great benefits. Anyone on medicare can get it. They also have a chronic SNP that is available if you qualify, obviously. But it’s actually worse than the regular plan.
The only reason people actually choose that plan, and the only reason it’s available is because it can be sold year round. Not for the benefits.

 

[fishfortwo]

And be careful, just because it’s a chronic plan, it doesn’t mean it’s better.

For instance, in FL Humana has a regular HMO that has great benefits. Anyone on medicare can get it. They also have a chronic SNP that is available if you qualify, obviously. But it’s actually worse than the regular plan.
The only reason people actually choose that plan, and the only reason it’s available is because it can be sold year round. Not for the benefits.

Exactly, the Humana plan in our area has a zero premium just like the regular HMO but the moop is 6700 for the SNP vs 4500 for the regular HMO. There are a few copays a tad higher on the SNP as well. It should only be used as a rest of the year option here.

 

[kgmom219]

Thanks all! And thank you to Springbok for reaching out, since he's in TX.

Did the suggestion. Turns out that BCBSTX MAPD PPO has insulin at Tier 1 and 2. Not some of them. All insulin is Tier 1/2.

Ran it at Medicare.gov and got a $3K difference between BCBSTX and the next closest MAPD. Being the cynical girl that I am, I assumed Plan Finder was wrong and called my BCBS guy. He immediately said "insulin?" I told him yes and he responded with "I keep telling you how much money you will make if you start selling MAPD. Just think what would happen with your JDRF network. I'm sending you the links to get AHIP done. Click." Damnit.