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New for 2022: Special Supplemental Benefits for People with Diabetes

At BayCarePlus Medicare Advantage, we believe our members should be able to have affordable, easy access to benefits that’ll help them effectively manage their diabetes and avoid serious illness.

The cost of insulin, testing supplies and other necessary items for diabetes should not be a barrier to getting the care you need. That’s why we’ve developed expanded benefits for our members with diabetes starting January 1, 2022.

Any BayCarePlus Complete or Premier plan members who’s been diagnosed with diabetes will receive these new benefits. This includes the Insulin Savings Program. Members will have a predictable, stable copay for Select Insulins during the Initial Coverage and Coverage Gap phases. You aren’t eligible for the Insulin Savings Program if you receive Extra Help from the government or are a member of the BayCarePlus Rewards plan. If you’re a member of the Rewards plan, insulins are covered at the regular tier cost-share.

BayCarePlus
Complete (HMO)

BayCarePlus
Premier (HMO)

Select Insulins $0-$35 Copay per month
(remains through the coverage gap)
Diabetes Supplies $0 Copay when using a network pharmacy or contracted durable medical equipment (DME) provider
Additional Over-the-Counter (OTC) Dollars +$25/Quarter +$50/Quarter
Expanded Dental Benefit Up to three routine cleanings and one deep cleaning every 12 months
Enhanced Podiatry Benefit $0 Copay for up to four routine visits/calendar year, which include nail trimmings $0 Copay for up to six routine visits/calendar year, which include nail trimmings
Extra Nutrition Counseling $0 Copay for four additional hours/calendar year $0 Copay for six additional hours/calendar year

Insulin Savings Plan

As a member of the BayCarePlus Complete or Premier plan, you’ll have low, predictable copays on Select Insulins† through our Insulin Savings Program.

Costs for Select Insulins will remain the same during the Initial Coverage and Coverage Gap phases of your prescription drug benefit. The program doesn’t apply during the Catastrophic Coverage stage.

(Note that this program is not available if you receive Extra Help from the government)

BayCarePlus
Complete (HMO)

BayCarePlus
Rewards (HMO)

BayCarePlus
Premier (HMO)

Standard Retail Cost-Sharing

Tier 2
Select Insulins
  • 30-Day Supply: $4 Copay
  • 60-Day Supply: $8 Copay
  • 90-Day Supply: $12 Copay
  • 30-Day Supply: Not applicable††
  • 60-Day Supply: Not applicable††
  • 90-Day Supply: Not applicable††
  • 30-Day Supply: $0 Copay
  • 60-Day Supply: $0 Copay
  • 90-Day Supply: $0 Copay
Tier 3
Select Insulins
  • 30-Day Supply: $35 Copay
  • 60-Day Supply: $70 Copay
  • 90-Day Supply: $105 Copay
  • 30-Day Supply: Not applicable††
  • 60-Day Supply: Not applicable††
  • 90-Day Supply: Not applicable††
  • 30-Day Supply: $35 Copay
  • 60-Day Supply: $70 Copay
  • 90-Day Supply: $105 Copay

Mail-Order Pharmacy

Tier 2
Select Insulins
  • 30-Day Supply: Not Offered
  • 60-Day Supply: Not Offered
  • 90-Day Supply: $0 Copay
  • 30-Day Supply: Not Offered
  • 60-Day Supply: Not Offered
  • 90-Day Supply: Not applicable††
  • 30-Day Supply: Not Offered
  • 60-Day Supply: Not Offered
  • 90-Day Supply: $0 Copay
Tier 3
Select Insulins
  • 30-Day Supply: Not Offered
  • 60-Day Supply: Not Offered
  • 90-Day Supply: $95 Copay
  • 30-Day Supply: Not Offered
  • 60-Day Supply: Not Offered
  • 90-Day Supply: Not applicable††
  • 30-Day Supply: Not Offered
  • 60-Day Supply: Not Offered
  • 90-Day Supply: $95 Copay

Select Insulins are those that are part of the Insulin Savings Program and therefore will incur low, consistent copays through the coverage gap. For information regarding which insulins are Select Insulins under the plan’s benefit, refer to the plan’s Prescription Drug Formulary. See the Evidence of Coverage for more information regarding Select Insulins, including full cost-sharing information.

††The Insulin Savings Program isn’t available if you’re a BayCarePlus Rewards member. If you’re a member of the Rewards plan, insulins on this tier are covered at the regular tier cost-share.

Plans may offer supplemental benefits in addition to Part C benefits and Part D benefits.

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