Leslie Newlife

Factors to Consider When Building a Senior Living Facility

None of us are getting any younger; most people plan for their retirements so that they can find a safe and healthy retirement community. Although, with so many people aging, many senior living communities are opening additional facilities or expanding on their current building. Unfortunately, expanding or building a senior living facility isn’t quite as simple as constructing other buildings. As the owner or administrators of a retirement community, you know there are specific characteristics of a retirement community. Before you begin building, we discuss some factors to consider when building a senior living facility. Read on to learn more.

Limit floors, stairs, and uneven surfaces

Trips and falls are among the leading causes of senior injuries. While some of the tenants at your facility might do stairs without any problems, the best solution is to avoid stairs as much as possible. If at all possible, your facility should be one floor to reduce the chances of someone falling. Additionally, you’ll want to make sure the floors are as flat as possible. Avoid even slight ramps to keep the surface consistent—otherwise, someone could fall.

Know your market and what they want

You might already know the demographic and preferences in your market if you’re expanding on an existing building. However, for those of you who are building a brand-new facility, you should always conduct market research for several reasons. First, for business purposes, you’re going to want to know who your customer is, their demographics, and their average wealth. On the other hand, you need practical information to build a great community. Every local community is different; some local areas have a lot of places to walk and you should always encourage seniors to exercise. Moreover, it’s important to offer at least some amenities like a barbershop and salon or a library to keep your residents satisfied.

Take technology into consideration

Technology is a vital factor for everyone at the facility. The staff will need a reliable internet connection to perform daily operations including billing, answering phones, and even marketing. Before construction begins, many building regulations require plenum Ethernet cables in certain areas of the building to reduce toxic chemicals in the event of a fire. Additionally (and similar to amenities), many seniors will want TVs, whether that’s in their room or in a living space somewhere in the facility. Lastly, while many seniors don’t care about technology as much as younger people do, they still might want the option to use a computer. Having a few community computers can help residents practice their computer skills, post on their social media accounts, and surf the web.

Of course, you’ll want to include safety measures into your plan, such as fire extinguishers, smoke detectors, and AED stations. Additionally, you should ensure you can monitor all your residents with cameras in commonplaces. With aging individuals, it’s always better to be safe than sorry, and taking the mentioned factors into considerations will help you build a great community.

How Seniors Can Increase Their VA Disability Ratings

Every American should be thankful for the bravery and selflessness of our senior veterans for their service in global conflicts like WWII and the Vietnam War. Many seniors live with the consequences of their service even today. For those that survive on only a small pension and their VA disability benefits, it’s often not enough to live the kind of life that they have earned.

Many seniors make the assumption that their VA disability rating is set in stone and cannot be upgraded. The truth is, that as time passes and age starts to contribute to injuries and syndromes attained during service, seniors have the opportunity to get more benefits.

In the following article, you will learn how to increase your VA Disability Rating and get the compensation that you need and deserve. Let’s take a look at a few tips to help you increase your rating and benefits range.

File For Secondary Service Connection

Instead of focusing on only your primary conditions, it can help your case to file for secondary service connection issues. These are conditions or injuries that are caused or aggravated by your primary issues. For this type of filing you will need causation, including a report from your doctor, the medical evidence of the connection to your primary issue and a medical Nexus letter.

High-Value Claims

High-Value claims are conditions or disabilities with a higher expectation of approval for benefits over 30%. These types of claims are often processed more quickly and provide for a higher payout. High-value claims included the following:

  • Mental health issues including PTSD, generalized depressive disorder, anxiety disorder, and somatic symptom disorder
  • Migraines
  • Sleep apnea
  • Respiratory conditions

Get A Buddy Letter

A Buddy Letter is a sworn statement made by a direct witness to your injury or condition. This can include a parent, spouse, fellow service members, a friend, coworker or pastor. These letters must contain lay evidence in support of your injury or condition based on observation or direct experience. The Buddy letter is intended to help veterans prove their claims based on an outside witness account. You can find a Buddy letter tutorial online here.

Score High On Your C&P Exam

Your Compensation & Pension exam is a vital part of getting your disability rating upgraded. Here are a few tips to help you ace your exam:

  • Know the details of your medical records
  • Get familiar with the ratings process and values
  • Share how you are living on your worst days
  • Share every detail no matter how uncomfortable

As seniors age, it’s common that injuries and conditions from their service will deteriorate and cause more problems and pain. Talk to your doctor and consult with a VA Disability lawyer to help you navigate the system and get the benefits that you have earned on behalf of your country.

4 Modern Challenges Nursing Homes Face

Nursing homes around the country care for the most vulnerable population—seniors and those experiencing severe illnesses. This vulnerability is most clear as the coronavirus spreads and, sadly, infects some of those in assisted living facilities. While stopping the virus is of paramount importance, there are also additional priorities nursing homes always have on their plates. To learn more about these diverse modern challenges nursing homes face, read on.

Disease Protocol Amid COVID-19

In the past months, every nursing home’s mission—a source of great anxiety for staff—has been to prevent residents’ COVID-19 exposure. The virus is extremely contagious and can pass from person to person quietly via asymptomatic virus carriers. This means people who don’t develop symptoms can transmit the sickness to people they contact. Especially salient for a home’s many elderly residents, this illness has an alarmingly high mortality rate as well.

In response to this threat, nursing homes developed intensive protective protocols. The CDC recommends they dedicate at least one person to managing an onsite infection prevention and control (IPC) program. Part of their responsibilities would be staff and resident education regarding the virus, as well as coordinating messaging to potential visitors. In many cases, it’s wise to restrict visits and suggest digital alternatives.

In addition, workers should consistently wear a face mask and go through temperature screenings. COVID-19 tests are appropriate should there be cause to suspect infection.

Daily Communication Gaps

Another less urgent but not entirely unrelated concern is communication within a nursing home. First, to ensure quality care for each person, workers must be able to talk with one another. The two-way radio can help greatly in this area. When staff is handling an emergency, having a radio at-hand allows them to secure back-up quickly. Also, messaging back and forth through a device simply saves time they would otherwise spend walking around the building looking for and talking with someone else.

Inconsistent Record-Keeping

The second facet of communication is an assisted living facility’s records. The paperwork they keep regarding each resident makes care precise, but staff members don’t always keep their documents in a centralized form. Nursing homes would benefit from expediently converting all records into a digital format to prevent logjams and promote good care.

Staff Recruitment and Retention Struggles

Our final modern challenge nursing homes face is consistent staffing. Because nursing home work is stressful, some workers in the industry move on. When homes cannot attract skilled caregivers to replace them, remaining qualified workers bear a larger burden and burn themselves out. Sometimes, nursing homes get into this negative staffing rut and struggle to recover. This illustrates the importance of reliable and substantial funding to keep people on staff and hire more to help.

Caring for Grandchildren During COVID-19

Grandparents know the deep joy that comes from watching our grandchildren growing up. Children help remind us of all the good things in our lives and ourselves. Unfortunately, this year has made it more challenging for us to spend time with our grandchildren because we can’t see them face to face. Instead of believing this is just the way it has to be, if we work with our children and grandchildren, we can help make this a year where our bonds become even deeper.

We all are finding this year to be a year filled with uncertainty, confusion, and even fear. The younger our grandchildren are, the more they need our perspectives as grandparents. Hearing stories of other times we’ve experienced challenges and how we overcame them can put what everyone is experiencing today into context. Various studies show that proximity to grandparents has many scientific benefits for both our grandchildren and ourselves. Some of these benefits include connection to heritage and identity, an extended support system, and a better quality of life – for everyone. Even if we are unable to see our children in person, we can still call and chat with them online.

Depending on our living situation and our particular health context, we can also support our grandchildren by offering to watch them. This might be informal watching like getting on a Zoom call and reading them a story, or having a virtual tea party so their parents can focus on other work. This might also be more formal, like picking them up from a child care provider listed on TOOTRiS.com, or other child care options available close to where we live. Providing either informal or formal assistance can both give our grown children room to breathe and create meaningful moments for our grandchildren. Children love routines, and someday they will tell stories to their children about the summer grandma or grandpa called every day to tell stories and listen to their adventures.

Keeping up with grandchildren can be hard. Grandchildren tend to become Tigger from Winnie the Pooh, bouncing all over the place. If we are connecting more with our grandchildren, virtually what can we do to keep up? One way is to incorporate them into all aspects of our senior fitness plans because staying physically and mentally healthy is important at any age. We might consider regular Wii Fit games or playing a game like Dance, Dance Revolution to get us all up and moving. We might come up with fun challenges like each person going for a walk separately and telling each other five things we saw, five things we heard, and five things we smelled. There are numerous ways to incorporate fitness into our time together. 

Sadly many of us do not have grandchildren or do not have close ties to them. We might wonder if this means we can’t connect with younger generations. The great news is the answer is usually no. There is a growing number of organizations that connect seniors with youth creating meaning and purpose for both groups. This is important because both us seniors and Generation Z are struggling with issues of loneliness and isolation.

While this year has made caring for grandchildren more complicated, it has not made it impossible. With a little bit of creativity and elbow grease, we can make this year a meaningful one. We can make this year a year that no one in our families will ever forget.

Key Considerations When Hiring an In-Home Nurse

For some seniors, declining health reduces their ability to care for themselves. From getting dressed and preparing meals to completing household chores and running errands, mastering everyday tasks presents a challenge. It is when this happens that seniors and their families must make a decision on how to improve their quality of life. While some may opt to move their aging loved ones in with them or transition them to a nursing home, many consider hiring an in-home nurse. 

What is an In-Home Nurse? 

An in-home nurse is commonly referred to as a home health caregiver or home care nurse. These are trained nursing professionals that provide medical and other assistance to patients in their homes.  

What Does an In-Home Nurse Do? 

The responsibilities of an in-home nurse are plentiful. Depending on the needs of the client nurses can assist with the administration of medication, injections, and therapeutic treatments. Home care nurses will also assist patients who have difficulties with daily living activities. This can include feeding, dressing, bathing, personal hygiene, and, getting around, using the restroom.

What to Look For? 

If you’ve decided that an in-home nurse is ideal for improved living, the next step would be to find the best candidate for the job. There are several agencies and independent nurses to choose from. In order to narrow down your options, it is highly recommended that you keep these considerations in mind. 

Education – an in-home nurse will be working regularly with their patient. It is their responsibility to administer medications, monitor conditions, and perform certain therapies. As such, it is essential that they have the necessary education. When looking for the right elder care nurse, consider their educational background. What medical education and training do they have? Did they utilize resources like Level Up RN for nursing students to obtain more knowledge and pass tests? Have they passed the required licensing and registration requirements in your state? 

Experience – Experience is another key consideration when hiring an in-home nurse. Beyond having an educational foundation, you want to know that the nurse you hire has had experience caring for seniors with your conditions. Don’t be afraid to ask how many years they’ve been in the industry? Do they speak English fluently? How many patients they’ve assisted? How many problems have occurred (and how they were resolved? 

Agency – If you prefer to hire a private nurse for senior care through an agency, do your due diligence. Conduct research to find out how long the agency has been in business, how clients and their families feel about the quality of service provided, what their qualifications are for hiring nurses, what policies and procedures are put in place to monitor nurse performance and patient care, and more. 

Comfort/Bedside Manner – You’re going to be spending quite a bit of time with your in-home nurse. Obviously, you want those interactions to be positive. Part of this means finding a nursing professional that makes you feel comfortable and has a good bedside manner. As you interview candidates to narrow down your options, pay attention to how they make you feel. Are they answering all of your questions? Are they patient and attentive to your needs? Do they have an overall upbeat personality? If you’re not connecting with them on a social level, this could make the in-home care experience complicated. 

Affordability – At some point, you have to consider the cost of hiring an in-home nurse for elderly care. Depending on the type of medical insurance you have, these services may only be partially covered (if they’re covered at all). Therefore, you want to go over the cost of in-home care and determine who can provide you with the best services at a rate you can afford. 

When the need arises in your life that you need assistance from others to care for yourself or perform regular activities, in-home care could be an effective solution. Be that as it may, it is imperative that you do your due diligence and keep the above-listed considerations in mind as you find one that best suits your needs.

The Facts of Senior Life: What Are the Benefits of Assisted Living?

Are you you considering moving to an assisted living community? Or maybe are looking into one for your older family member that you can’t take care of or leave on their own.

This can be a hard decision, especially if you’re not clear on what assisted living involves. What are the benefits of assisted living? Many different factors affect joining an assisted living home and we’ll tackle them all.

Learn more about what goes on in an assisted living home with our guide below. Discover why you should be investing in assisted living for you or our family members.

What Is Assisted Living?

An assisted living home or assisted living facility is a housing facility usually for the elderly. It’s for anyone who can’t live or support themselves independently.

It provides housing, personal care, and health care if you have any underlying conditions. Similar to a retirement home or a nursing home, it promotes retirement care but still gives residents an active social life.

When looking at assisted living it’s important to take your time to find the best assisted living community for you to your loved one.

Social Interaction

Loneliness is a big concern and can lead to depression for many seniors. Too much isolation can even lead to higher mortality rates.

While affecting your mental health, chronic loneliness can lead to physical problems. This includes issues linking to dementia and heart disease. It is also correlated with alcohol and prescription drug abuse.

Staying in an assisted living community lets you interact with other people and make strong bonds with those taking care of you. Assisted living is a great way to stay active and engaged and improve happiness.

Increased Health

Most assisted living communities offer different classes for physical fitness. Living on your own might not give you the right push or motivation you need for exercise. But if you’re in an assistant living, there are more opportunities for you to participate in physical activities and programs.

Along with exercising, assisted living also includes healthy and nutritious meals. It can be challenging to make sure that you’re getting the right nutrients even if you have a caregiver. When it comes to assisted living, all your meals are prepared for you.

Assisted living communities will often have a professional chef to cook and serve all meals. Every meal will follow a properly balanced diet and provide the required vitamins and minerals. The staff strives to make each meal delicious to encourage eating.

They also stick to and include any dietary needs and restrictions especially for those who have diabetes or allergies.

Increased Hygiene

As you get older, keeping up with your cleanliness and overall health can be a struggle. Things like bathing and laundry become a challenge when you try to do them yourself. With assisted living, help is always available to tackle these tasks without too much difficulty.

They also help to remind you to keep up your hygiene and follow a schedule.

Less to Worry About

When you’re in an assisted living home, everything gets taken care of for you. This eliminates the stress of worrying about and keeping up with your house responsibilities. Any bills, housekeeping, or chores are in the hands of the staff.

Safe transportation is also available for use whenever you have a doctor’s appointment. This is for medical care that isn’t already provided.

Residents can feel the assurance that they’re surrounded by a community that cares and looks out for them.

24/7 Safety and Care

Since assisted living homes have constant maintenance, there is never a threat of security or health risks. Care is around the clock. Here are some safety benefits that assisted living provides.

Fewer Falls

According to a study from NCOA, every 19 minutes an older adult dies from a fall. Since there’s 24/7 assistance and monitoring in these centers, there are people to watch over and prevent falls.

Assisted living homes ensure residents’ safety. With house features like ramps, hallway hand railings, flat thresholds, and other specially designed facilities.

Less Medical Emergencies

In assisted living homes, you can rest assured that there is a system to notify any staff members available when something unfortunate happens. This gets rids of the struggle to get help yourself when you come across any health problems.

Stop Boredom

When you’re living by yourself, sometimes there isn’t too much that you can do. After retirement, you suddenly have to face hours of isolation and boredom.

Most assisted living communities provide different programs and activities you can join to make staying there more fun and engaging. This allows you to pick up a hobby you’ve always wanted to try, follow any forgotten passions, or make new acquaintances.

 

5 Things You Should Know About Fitness for Seniors

These are supposed to be the best years of your life — the retirement years, the golden years. Your quality of life will likely be a result of two lifestyle factors: diet and exercise. One of the benefits of keeping fit is increased mobility and balance–two factors that are of immense value to seniors. An exercise regimen can help you sleep better, feel more self-confident, lose weight, and alleviate some of the symptoms of arthritis. By following a few tips, you can enjoy the benefits of being a fit perennial.

Preventative Care is the Best Care 

Before deciding on changes to your daily routine, talk to your medical provider. Your doctor will have great advice for you and can help steer you towards eating the right foods, getting enough rest, and participating in the right activities that benefit your fitness. 

Even if your overall health is right, you need regular check-ups. Just because you look and feel great doesn’t always mean you shouldn’t have your regular check-ups. Remember, preventive care is the best care. Stay on top of your fitness and overall well-being by regularly speaking with your medical provider–and be honest with them. Regular screenings should include physical and mental health. Both are important.

A safety assessment of your home would also fall under the subject of preventative care. One of the leading causes of death in people over 65 is injury related to falls. While physical fitness can help avoid injury, certain safety measures are also worth considering.

Eat the Right Foods

Research shows that a proper diet can help prevent and reverse heart disease and other chronic issues. These can include hypertension, obesity, strokes, type 2 diabetes, and autoimmune conditions. One of the foremost cardiologists in the field of plant-based science, Dr. Caldwell Esselstyn, writes: “There is broad evidence that plant-based nutrition is the key to abolishing chronic disease. Epidemiological studies of cultures that have traditionally plant-based diets confirm an absence of the common chronic diseases that kill so many Americans.” You can learn more by researching the works of Dr. Esselstyn and his colleagues, such as Dr. Colin T. Cambpell, Dr. Michael Greger, Dr. John McDougall, and Dr. Will Bulsiewicz, to name a few.

Give Love to Your Mental Health 

If you don’t think that mental health impacts your fitness, think again. When your mental health isn’t sharp, you are not fit. No matter how thin you become or how muscular you appear, poor brain health eventually will catch up with you. More serious mental health conditions can develop for you, and your physical well-being also can suffer. 

Don’t ever be embarrassed to seek care for your mental health. Your primary medical provider can be of service here. And if needed, they can refer you to specialists and other resources that could benefit you. 

In the vein of preventative care, it might be beneficial to try meditation or yoga classes. Life can be stressful, and a calm mind is important. It’s also nice to interact with the types of people you generally find in meditation or yoga class.

Try a Gym Membership 

It’s important to exercise, and one of the easiest ways to do that is to join a gym. Light aerobic exercises like cycling, jogging, swimming, and walking can get you in shape and help you remain fit. Many gyms offer classes specifically for seniors. If you’re really feeling gung-ho, you might want to consider hiring a personal trainer. An additional bonus to a gym is that you can exercise come rain or shine. Going to the gym gets you out of the house; it helps you make new friends and socialize with old ones.

In closing, let’s look at one of the most common reasons perennials avoid a fitness routine. Some believe that they’re too old to start exercising. However, it’s important to know that you’re never too old! If it has been countless years since you’ve worked out, talk to your doctor. And find an exercise routine that focuses on gentle activities. You can work your way up to more advanced exercise slowly and gradually.

How to Make Your Senior Community More Eco-Friendly

As the world becomes more concerned about environmental issues, the demand for greener facilities continues to grow. Retirement communities, nursing homes, and other senior communities are no exception. People of all ages want to do their part to protect the world they live in, and they know that true change starts at home. Fortunately, you don’t need a massive budget to create a more environmentally responsible building and community. Start taking steps in the right direction with this guide on how to make your senior community more eco-friendly.

Focus on Sustainable Energy

If you want to reduce your community’s carbon footprint, a good way to start is by looking at your energy usage. Look into installing solar panels for your building. While this is certainly an investment, it can save you in the long run as you cut energy costs and even receive potential rebates or payments from your local government or energy companies. However, even without alternative power sources, you can still cut energy costs and usage by switching to more energy-efficient appliances and utilities. You can also implement LED bulbs, high-efficiency showerheads, and smart devices to reduce the amount of energy and water your facility uses each day.

Go Green Inside and Out

In the fight against climate change, no idea or solution is too small. There are plenty of things you can do both inside and outside of your senior community. Try to come up with eco-friendly interior design solutions, such as using sustainable construction materials or purchasing your décor from a secondhand or antique shop. You can establish some outdoor eco-friendly solutions as well. For example, a community garden is a great way to plant more trees and preserve native plant life in your community.

Get Residents Involved

When it comes to how to make your senior community more eco-friendly, the most effective solutions are a team effort. Get your community involved by starting green committees, implementing recycling programs, and encouraging other initiatives. The more people you have working toward these projects, the better your ideas, efforts, and results will be. This is also a fantastic way to bring residents together and create a tight-knit, enriching community within your facility.

5 Key Things to Look for in an Independent Living Community

Are you looking for a great independent living community for yourself or a loved one? Maybe you’re just testing the waters to see what’s out there.

Almost 90% of residents living in independent living communities are enjoying their time there, and nearly as many would recommend it to a friend. Maybe it’s your turn to take the plunge and join one yourself!

How do you find the right community though?

This is where the hard part comes in. There are so many options, especially if you’re not constrained by location. How are you supposed to choose the right independent living facility for you?

We’re here to help you narrow down your search.

Keep reading for a few things that you should look for when you’re deciding on your next home.

  1. Cost

Let’s get this out of the way first. Cost is an important factor when you’re considering a new home.

Everyone has different budgetary concerns. You may have been saving up for this for your entire life! If that’s the case, you may not be as worried about how much your new independent living facility is going to cost you.

Most people, though, don’t have that privilege. They might be limited by the money that they have available to them.

While some communities are definitely closer to “luxury”, they often come with luxury prices.

Make sure that you’re getting the features that you need before the ones that you want and then go from there. Be careful not to overspend.

Independent living communities can cost thousands of dollars per month, and sometimes that price is just the basics. More amenities will require more money. Make sure you know that you’re able to cover the costs.

  1. Amenities Offered

Not all senior living communities are created equally. As we mentioned under “cost”, some of the facilities with more luxurious options are also going to be hard on your wallet.

That said, it’s important that you’re happy in your new community, so looking for certain non-negotiables is important.

Is there free parking or transportation? Is there a laundry service, or do you clean your own? If you clean your own, are the machines free or paid (and are they in your unit)?

You might also be interested in specific amenities. Maybe your new home has to have a gym or a pool. Maybe it has to have some kind of clubhouse where you can congregate and make friends.

Make a list of the things that you need and want and see how your options stack up.

  1. The Community Itself

Sometimes independent living communities will have mixers where you (as a non-resident) can go hang out with the people who are already living there. This is a great opportunity to see what the place is actually like straight from the mouths of those who are staying there.

You can get real answers to any of your questions while socializing a bit with the locals.

This is also a good opportunity to see if you really get on with the people who are already there. Let’s face it, not every community is going to suit every person.

If this group is a bit quiet or uptight and you’re the kind of person who likes to hang out and let loose with friends, this might not be the best community for you. Maybe you just don’t like these people. There’s no shame in that.

You’re doing this to figure out where your place in the world is. Take every opportunity that you can to ensure that you do so correctly.

If the community isn’t fulfilling for you, move on. You’ll be spending a lot of time in this new home, so you need to get the right fit for your own social health.

  1. The Location

When you’re moving into an independent living community you get to decide where you want to live. This doesn’t just mean the facility itself, but also the location.

Do you dream of living in a warm, tropical climate? Maybe the beach is a few steps away and you can sit out by the pool with your new friends.

Maybe you want to live in the mountains. You want beautiful views and to finally see what that fresh mountain air is all about.

You have these options when you’re choosing a new home.

However, maybe it’s more important to you that you live close to your family. Moving into the city where your children or grandchildren live might be a priority.

Don’t exclusively look for places in your direct area. You have options!

  1. The Care

You’re probably moving into independent living because you’d like the security of a community and the ease of assistance when you need it.

Some communities are more independent than others.

If you have specific health needs that should be addressed, you should know whether or not these things will be made available to you.

Are there nurses or assistants available at the community itself for small needs? Is there an in-house medical team? How close is the hospital, and are they efficient with transportation?

Knowing these things ahead of time will help you plan and determine if this new facility is going to be right for you.

Are You Ready for Independent Living? 

Making the transition from a “normal” home to an independent living community doesn’t have to be jarring. It can just be your next big adventure!

Choose a place and community that you can truly blend into. This is the start of an awesome new stage of life, so you should enjoy it!

For more posts like this on senior living, visit the rest of our site.

White House Announces in 2021 $35 Max Copay for Medicare Beneficiaries that Use Insulin

The majority of people in the United States diagnosed with diabetes are Medicare beneficiaries. Of the Medicare beneficiaries with diabetes, 3.3 million rely on some form of insulin to manage their disease. Insulin has been the leading treatment for diabetes for 100 years now.

In 1910, a researcher realized one particular pancreatic substance was missing in people with diabetes, and he called it insulin. Eventually, in 1922, the first human received an injection of insulin extracted from cattle. Since then, scientists have developed various forms of insulin, saving millions of people’s lives across the country.

However, as the medical marvel’s popularity and effectiveness grew, so did its price. In 2001, Eli Lilly’s Humalog cost $35 for a one-month supply. By 2019, that same one-month supply cost nearly $300. The Centers for Medicare and Medicaid Services (CMS) are happy to announce that the cost of insulin will soon return to its once low monthly rate for its beneficiaries.

The Part D Senior Savings Model of 2021

As of 2021, Medicare beneficiaries enrolled in a Part D Senior Savings Model plan will spend no more than $35 for their monthly supply of insulin. The Part D Senior Savings Model caps all covered insulin at a $35 max copay. However, Part D plan sponsors have the option to offer even lower copays if they wish.

Part D plan sponsors and drug manufacturers are not required to participate in the Part D Senior Savings Model of 2021. Though, over 1,750 Part D plans agreed to participate. The top three insulin-producing drug manufacturers, Sanofi, Novo Nordisk, and Eli Lilly, have also opted in.

Part D plan sponsor requirements

For a Part D plan to join the new Model, they must meet specific requirements. Model Part D plans must cover both a vial and pen dosage form for each insulin included on the plans’ formulary. All four types of insulin must also be included within the drug formulary – long-acting, short-acting, intermediate-acting, and rapid-acting. If the Part D plan sponsor agrees to these formulary requirements, they can participate in the Part D Senior Savings Model.

By joining the Model, the Part D plan sponsor agrees to a maximum copay of $35 for all covered insulins. This maximum cannot be increased based on brand, type, pharmacy, or plan stage. Basically, $35 is the maximum a 30-day supply of insulin can cost under a Model Part D plan no matter what.

Drug manufacturer requirements

For a drug manufacturer to join the new Model, they must agree to offer all of their insulin products to the Part D plan sponsors as part of the Part D Senior Savings Model. Drug manufacturers participating in the Model can’t choose to exclude any insulin product from the Model.

Potential savings under the Part D Senior Savings Model

According to the Kaiser Family Foundation (KFF), on average, Medicare beneficiaries pay nearly $4,000 a year on insulin[1]. Under the new savings Model, Medicare beneficiaries will pay $420 or less a year on insulin. That’s almost a 90% discount.

One of the biggest benefits of the new Model is the stability of the lower copay. Instead of paying fluctuating copays throughout the year for their insulin, Medicare beneficiaries will pay the same lower copay all year long. For example, in 2020, a Part D enrollee pays no more than 25% for their insulin prescription during the coverage gap. For an insulin prescription that costs $300, that’s a $75 copay. In 2021, that copay will be cut in half.

Enrolling in a Part D Senior Savings Model plan

CMS expects that there will be Part D Senior Savings Model plans available in all states and Puerto Rico. The available Model plans will either be in the form of a standalone Part D drug plan or included in a Medicare Advantage plan.

The soonest a Medicare beneficiary can apply for a Part D Senior Savings Model plan is during the Annual Election Period that starts on October 15, 2020. However, Model plan information will be available as early as September. Model plans purchased between October 15, 2020, and December 7, 2020, will be effective on January 1, 2021.

Medicare beneficiaries can use the Medicare Plan Finder Tool to browse available Model plans in their area prior to enrolling. Once enrolled, beneficiaries can kick back and wait for their savings to start rolling in.

[1] https://www.kff.org/medicare/issue-brief/how-much-does-medicare-spend-on-insulin/