The 2021 Part D Senior Savings Model
For diabetics, access to insulin is a critical component of their medical care. Failing to effectively manage diabetes results in increased risk of serious complications, ranging from vision loss to kidney failure to foot ulcers, amputations and heart attacks. Unfortunately, for many seniors the cost of insulin is a barrier to appropriate medical management of diabetes.
CMS Part D Senior Saving Model is designed to address President Donald Trump's administration promise to lower the prescription drug costs and provide Medicare patients with new choices of Part D plans that offer insulin at an affordable and predictable cost where a month supply of plan-formulary insulin costs to $35 each.
Lower Medicare Part D costs for Insulin
Medicare Insulin Coverage Program Details - Senior Savings Model
The new Senior Savings Program allows for Medicare Part D sponsors to offer a Part D benefit design that includes predictable copays in the deductible, initialcoverage, and coverage gap phases by offering supplemental benefits that apply after manufactures provide a discounted price for broad range of insulins included in the program.
The Senior Savings Model aims to reduce Medicare expenditures while enhancing the quality of care for seniors, and to provide beneficiaries with additional Medicare Part D Plan choices. There are participating stand alone Prescription Drug Plans and Medicare Advantage Prescription Drug Plans.
Beginning January 1, 2021, Medicare Part D sponsors that participate in the program will offer beneficiaries Prescription Drug Plans that provide supplemental benefits for insulin coverage in the coverage gap phase of the Medicare Part D benefit. Participating pharmaceutical manufactures will pay the 70% discount in the coverage gap for the insulins that are included in the program (click image above to see which insulin drugs are covered in the new Medicare Insulin Program), but those manufacturer discount payments would now be calculated before the application of supplemental benefits under the program.
As a result of the new program, seniors who take insulin and enroll in a plan that is participating in the Seniors Savings Model would now be saving on average $446, in annual Out-Of-Pocket costs of insulin, which is savings of about 66%. This predictable copay will provide improved access and affordability of insulin.
Participating Pharmaceutical Manufactures
Eligible Pharmaceutical manufactures had the opportunity to volunteer to participate in the Senior Savings Model. The following Pharmaceutical Manufactures are participatingin the Medicare Part D Senior Savings Program in 2021:
Eli Lilly and Company
Novo Nordisk, Inc.
Novo Nordisk Pharma, Inc.
Sanofi-Aventis U.S. LLC
Across the nation, 1,635 Prescription Drug Plans, including both Medicare Advantage Prescription Drug Plans and Stand alone Prescription Drug Plans are participating in the Senior Savings Model for 2021. This covers an estimated 13.2 million enrollees. Seniors who use insulin in all 50 States, D.C., and Puerto Rico will have a choice of a Medicare Part D Senior Savings Model participating plan in their area.
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Medicare/Medicaid/Insurance in Lafayette, CO
When an older adult needs help at home and sees several clinicians, a coverage decision can affect everything from prescription refills to rides. If youre considering TRU PACE in Lafayette, start by asking how enrollment would change the care and coverage you already use. How Medicare and Medicaid Fit Into PACEPACE is the Program of All-Inclusive Care for the Elderly. It coordinates healthcare and support for eligible adults who meet a state standard for nursing home-level care and can live safely in the community with PACE support at enrollment. Applicants must also be 55 or older and live in the programs service area. TRU PACE and Your Current CoveragePhone: 303-665-0115Medicare says people with Medicaid pay no monthly PACE premium. Medicare beneficiaries without Medicaid pay premiums for the long-term care portion and Medicare Part D drugs. Medicare also says participants owe no deductible, copayment, or coinsurance for drugs, services, or care approved by their PACE team. Ask TRU PACE for an estimate based on your individual coverage before enrolling. Doctors, Prescriptions, and Existing ServicesTRU PACE says it becomes the participants insurance provider at enrollment. Participants generally receive care through the programs provider network. Bring a list of your doctors, medications, and scheduled services. Ask which providers are in the network and how the team would coordinate any changes. Why This Matters in LafayetteIf you regularly see a clinician near home or have a specialist visit scheduled outside Lafayette, give the enrollment team the names and dates. Ask which appointments can continue and what to do about any refill due around the enrollment date. How to Get Started1. Gather Your Coverage InformationHave your Medicare and Medicaid information, if applicable, along with details of any current plan. List the appointments and prescriptions you rely on most.2. Ask for an Enrollment and Cost ReviewCall TRU PACE and ask for your expected monthly cost, when any coverage change would take effect, and who would help coordinate the transition. Related Seniors Blue Book CategoriesPACE Adult Day Services Care Management
Choosing the Right Corner of the Grand Valley for Your Next Chapter
If youve ever driven from Fruita through Grand Junction and out toward Clifton, youve seen how much variety fits into one valley. Same mountains, same sky, but each community has its own rhythm.Choosing where to live in retirement is partly practical and partly a matter of feel. Heres a friendly look at how to think about all three.A Quick Note Before We BeginEvery persons needs differ, so this is not a ranking. Its a set of questions and observations to help you decide what fits your life. Always visit in person if you can.Grand Junction: The HubGrand Junction is the largest community in the area and the center of many services. Residents have access to a range of medical offices, shopping, restaurants, and cultural options, including a veterans medical center for those who are eligible.Why people consider it: Closer access to healthcare and services A wide mix of neighborhoods and housing types Plenty of places to gather, from parks to local events Questions to ask yourself: Do I want to be near a lot of activity? Will I appreciate having services close by? Clifton: Close but CalmerClifton lies just east of Grand Junction. Many people think of it as a convenient, more residential option, with easy access to Grand Junctions amenities.Why people consider it: A suburban feel with nearby services Convenient connections to the rest of the valley Housing options that may suit different budgets (check current listings for specifics) Questions to ask yourself: Do I prefer a quieter setting without being far from town? How do I feel about driving to appointments or errands? Fruita: Small-Town SpiritFruita sits to the northwest and has a well-known reputation for outdoor recreation, particularly mountain biking, along with a lively downtown and community events. It is also close to the Colorado National Monument.Why people consider it: A distinct small-town identity Easy access to trails and open spaces A strong sense of community Questions to ask yourself: Do I want a smaller-town atmosphere? How far am I comfortable being from specialized medical care? Build Your Personal ScorecardRate each of these from not important to essential: Distance to doctors and hospitals Distance to family and friends Walkability or easy errands Quiet and privacy Access to nature and recreation Cost of housing and ongoing expenses Community activities and social opportunities Then compare the three communities against your list. You may be surprised by the result.Try Before You CommitSome ways to get a real feel for a place: Spend a weekend morning at a local coffee shop. Visit a grocery store, library, or community center. Drive the route to your doctors office at different times of day. Chat with people who live there. Visit in different seasons, if possible. A Local Guide Who Knows All ThreeCindy Amann of Bray Real Estate serves Clifton, Fruita, and Grand Junction as a Seniors Real Estate Specialist. Her own story is a Grand Valley story. She grew up in New York and spent 25 years in the Denver area with her husband while raising their two children. After their son moved to Grand Junction, they bought a second home here, spent more and more time in it, and eventually made it their permanent home.She says she loves the smaller-town feel and what the valley offers, and she knows firsthand how a place can win you over gradually. As a REALTOR with more than ten years of experience, she focuses on listening to clients and explaining each step so they feel confident.Remember: The Best Place Is the One That Fits YouSome people want a lively hub. Others want a peaceful street. Some want trails right outside the door. Theres no wrong answer, only the one that suits your life.Quick takeaway: Grand Junction, Clifton, and Fruita each offer something different. The right choice depends on your priorities, routines, and the people who matter to you.Frequently Asked QuestionsWhich community is closest to medical services? Grand Junction has the largest concentration of medical offices and facilities in the valley. Clifton is nearby, and Fruita is a short drive away. Confirm distances to your specific providers.Is Fruita only for active outdoor enthusiasts? No. While its known for recreation, many residents simply enjoy the community feel, local events, and scenery.Can I compare homes in all three communities with one agent? Yes. Cindy serves all three areas and can help you compare options.Should I rent in the valley before buying? Some newcomers find that helpful, though it depends on your circumstances. Discuss the options with a REALTOR and your financial advisor.What if Im moving from out of state? Visit if you can, and ask questions about local services, seasons, and community life. Cindy has made a major move herself and understands the process.Come See the Valley Through Local Eyes If youre curious about Clifton, Fruita, or Grand Junction, a conversation with Cindy is a friendly place to start. Visit her Seniors Blue Book listing to learn more and connect. More information can be found on her Seniors Blue Book listing.
A Home Livability Checklist for Grand Valley Seniors
Here is a question worth asking at least once: Does my home still work for the life Im living now?For some people, the answer is yes, perhaps with a few changes. For others, its a sign it may be time to consider something different. Neither answer is wrong. This checklist helps you look at the question calmly.First, What Does Livability Really Mean?Livability is about how well your home supports your daily routines, safety, and independence. Its not about size or style. A small house can be highly livable, and a large one can be exhausting.Walk Through Your Home: The ChecklistGrab a notepad and walk through each area. Note anything that feels difficult or uncomfortable.Entrances and Exits Are there steps at the front or back door? Is the walkway even and well lit? Can you carry groceries in without strain? Bathrooms Is it easy to get in and out of the tub or shower? Is there space to move comfortably? Would grab bars be possible? Bedrooms and Stairs Is your bedroom on the main level? Do you use stairs daily, and how do they feel? Is there good lighting at night? Kitchen and Living Areas Can you reach frequently used items without stretching or climbing? Is the layout comfortable for how you cook and gather? Yard and Exterior How much time and effort does upkeep take? Is snow removal manageable in winter? Are summer irrigation and lawn care becoming burdensome? Western Colorado sees real seasons, and a yard that was a joy at 55 can become a chore later. Thats worth considering honestly.Count the Items, Then Consider the PatternIf you checked off only a few concerns, small updates may be all you need. If many areas feel difficult, thats useful information too.Possible paths include: Stay and adapt: Make modifications, such as better lighting, grab bars, or a more convenient layout. Stay with support: Arrange help for yard work, cleaning, or home maintenance. Move to a more manageable home: Consider a single-level home, a smaller lot, or a community with maintenance included. Think Beyond the House: Location MattersThe Grand Valley offers a range of settings: Grand Junction provides a larger concentration of medical, shopping, and community services. Clifton offers a more suburban feel, close to Grand Junction. Fruita has a distinct small-town identity and close access to outdoor recreation. Which fits best depends on your preferences, not on a formula. Some people want to be near services. Others value quiet streets or a particular community feel. Its worth visiting each area at different times of day before deciding.Questions to Ask About Any Potential New Home Is it a single-level layout, or can the main living areas be on one floor? How far is it from your doctor, pharmacy, and grocery store? What are the maintenance responsibilities? Are there HOA fees, and what do they cover? Is it near family or friends? Why Experience With Senior Moves MattersA Seniors Real Estate Specialist is trained to look at housing decisions through the lens of this life stage. Cindy Amann of Bray Real Estate serves Clifton, Fruita, and Grand Junction, and she begins by listening to what her clients need. She has been a REALTOR for more than ten years, and she describes honesty, integrity, and putting clients needs first as the heart of her work.Cindy also lives in the Grand Valley and enjoys its outdoor lifestyle, from hiking and mountain biking to skiing. She can speak to what its like to live here, not just sell here.A Note About PressureYou dont have to make a decision because a checklist suggested one. Think of it as a conversation starter with yourself and your family. Take your time.Frequently Asked QuestionsHow do I know if its time to move? Look for patterns: daily tasks that have become difficult, safety concerns, or a lifestyle that no longer fits your home. Talking with family and a trusted professional can help.Can I make my current home safer instead of moving? Often, yes. Lighting, grab bars, and layout adjustments can make a difference. Consult qualified contractors for modifications.Is it better to buy or rent when downsizing? It depends on your finances and goals. A REALTOR can explain the housing side, and a financial professional can advise on your personal finances.Which Grand Valley community is best for retirees? Theres no single answer. Visit Grand Junction, Clifton, and Fruita to see which feels most like home.Can Cindy help if Im not sure Im ready? Yes. A conversation doesnt commit you to anything.Take the Next Step If this checklist raised questions, youre not alone. Visit Cindy Amanns Seniors Blue Book listing to learn how she helps older adults and their families. More information can be found on her Seniors Blue Book listing.