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Health Care Reform:

Health Insurance & Affordable Care Act

How Health Care Reform Affects Your Diabetes Care

Health plans cannot deny coverage to people with diabetes. And, they must offer a range of benefits that help you manage your illness.


Savings on Mail-Order Diabetes Supplies for Seniors

The National Mail-Order Program can be used to order diabetic supplies and have them delivered to your home. It costs the same to purchase diabetic supplies whether you get them delivered to your home or purchase them in the store. Some diabetic supplies that can be ordered through a mail order program include:

  • Test strips
  • Lancets and lancet devices
  • Batteries
  • Control solution

You can only use this program if you have traditional Medicare. If you use a Medicare Advantage plan, ask your plan where to get supplies.

Medicare will pay 80% of the cost of your diabetes supplies after you pay your deductible. You pay 20% of the costs.

You can buy supplies by mail order or from a store. But you must buy them from a Medicare-enrolled supplier to get this discount.

Ask your pharmacy if they accept "Medicare assignment." Or call 800-MEDICARE (800-633-4227) to find ones near you that do.   

Savings on Drug Costs for Seniors

The new law is helping to close the gap in Medicare coverage for prescription drugs. You probably know this gap as the donut (doughnut) hole.

The donut hole occurs after you and your health plan have spent a combined amount of $2,960 in 2015 and $3,310 in 2016. After you hit that amount, you’re in the donut hole. That means your health plan will not help pay for your medicines again until you have spent another $4,700 in 2015 and $4,850 in 2016.

However, it's getting easier to afford your prescription drugs, and it will continue to get easier as the donut hole shrinks. This is great news for older adults with diabetes who use insulin or take diabetes medicine.

Donut hole shrinks. While in the donut hole, in 2016 you will pay 45% of the cost for a brand-name medicine. This will steadily decrease to 25% in 2020. After 2020, the donut hole will close and you will only pay 25% of the costs of your drugs until you reach the yearly out-of-pocket spending limit..

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