- SilverScript Medicare Part D prescription drug plans are available nationwide.
- Members have access to more than 65,000 pharmacies across the United States.
- SilverScript offers three Medicare Part D plan options in 2021.
SilverScript offers three different plans this year, including one with a $0 deductible on all covered drugs. Members have access to a large network of more than 65,000 pharmacies around the country, as well as several thousands of preferred pharmacies for extra discounts.
In this article, we’ll explore the prescription drug benefits offered by SilverScript, including an overview of the plan options and their costs.
SilverScript offers three different Part D plans:
- SilverScript SmartRx
- SilverScript Choice
- SilverScript Plus
SilverScript Choice and SilverScript SmartRx plans are available to residents of all 50 states. SilverScript Plus is available to residents of every state except Alaska.
SilverScript offers prescription drug coverage through three different Medicare Part D plans. Here’s an overview of each option — we’ll dive deeper into price details later in the article.
The SilverScript SmartRx plan is intended for active, generally healthy adults who take generic maintenance drugs or no regular medications. Its formulary offers a substantial list of tier 1 drugs at a $0 copay at preferred pharmacies during the initial coverage phase.
With this plan, you may be able to enroll for a $0 premium if you’re enrolled in Medicare’s Extra Help program. You’ll also pay a $0 deductible on tier 1 and 2 drugs and $0 copays for tier 1 drugs at preferred pharmacies during your initial coverage phase.
The SilverScript Plus plan offers more covered drugs on its formulary, extras like discounts on some vitamins and minerals, and enhanced
coverage during the donut hole phase.
Coverage phases for Medicare Part D
After you’ve reached the initial coverage limit, you move into the coverage gap, also known as the donut hole. Different plans will charge you set copay amounts for your medications during this gap phase.
You leave the donut hole and enter the catastrophic coverage phase once you’ve paid $6,550 out of pocket for prescription drug costs for the year. In the catastrophic phase, you’ll pay 5 percent of the medication cost or $3.70 on covered generics (whichever is greater) and $9.20 on covered brand drugs for the rest of the year.
SilverScript Part D plans have many coverage benefits, including:
- $0 copays for preferred generics
- access to a network of more than 65,000 pharmacies nationwide
- lower copays at more than 18,500 pharmacies for SilverScript SmartRx and 23,000-plus pharmacies for SilverScript Choice and SilverScript Plus
- cost savings for 90-day mail-order refills
- formularies that cover nearly all the drugs commonly prescribed to Medicare members
What are Part D formularies?
All Part D plans have a list of prescription medications they’ll cover. This list is called a formulary.
Your plan’s formulary will divide prescriptions into groups, called tiers. The tiers for prescription plan formularies are typically broken down like this:
- tier 1: preferred generic
- tier 2: generic
- tier 3: preferred
- tier 4: nonpreferred
- tier 5: specialty
Your plan will have a set copay for each tier.
There can be a variety of different costs that come with Medicare Part D plans, including deductibles, premiums, copays, coinsurance, and more. Next, we’ll take a look at what these costs are with SilverScript plans in 2021.
Here’s a breakdown of how each plan handles annual deductibles:
- SilverScript SmartRx: $0 deductible for tier 1 drugs and a $445 deductible for tiers 2 to 5
- SilverScript Choice: $0 deductible for tier 1 and tier 2 drugs and a deductible from $205 to $445 for tiers 3 to 5
- SilverScript Plus: $0 deductible on all covered drugs
Premiums for SilverScript plans can start as low as $0 if you qualify for Extra Help. If not, here’s the range of monthly premiums you’ll pay for each plan in 2021:
- SilverScript SmartRx: $5.70 to $7.80
- SilverScript Choice: $18.10 to $49.70
- SilverScript Plus: $52.20 to $88.60
These rates vary depending on where you live. You can enter your specific ZIP code to search for prices using Medicare’s plan finder tool.
As with all Part D plans, the premium for your SilverScript plan is in addition to the other costs you pay for Medicare.
There’s typically no premium for Part A, but Part B does have a monthly premium. So, if you’re using original Medicare (parts A and B together), you’ll need to pay the Part B premium and the premium for your SilverScript plan.
If you have a Medigap plan or Medicare Advantage plan without Part D coverage, you’ll also pay those premiums in addition to that of your Part D plan.
Copays and coinsurance
Your medication copays with SilverScript will depend on your plan and on your prescriptions. Here are some of the main differences between the plans.
- Tier 1: $0 at preferred pharmacies and mail-order service; $19 for a 30-day supply at nonpreferred pharmacies
- Tiers 2 and 3: $19 to $141 (range for all pharmacies and supply amounts)
- Tier 4: 48 percent to 50 percent coinsurance
- Tier 5: 25 percent coinsurance for a 30-day supply
- Tiers 1 and 2: $0 at preferred pharmacies and mail-order service; $5 to $33 for all pharmacies and supply amounts
- Tier 3: $35 to $141 range for all pharmacies and supply amounts
- Tier 4: 41 percent coinsurance
- Tier 5: 27 percent coinsurance for a 30-day supply
- Tier 1: $0 at preferred pharmacies and mail-order service; $5 to $15 at nonpreferred pharmacies
- Tier 2: $0 to $2 at preferred pharmacies and mail-order service; $10 to $30 at nonpreferred pharmacies
- Tier 3: $47 to $141 range for all pharmacies and supply amounts
- Tier 4: 50 percent coinsurance
- Tier 5: 33 percent coinsurance for a 30-day supply
Medicare parts A and B, also known as original Medicare, don’t offer coverage for prescription drugs. Medicare Part A is hospital insurance for inpatient stays, while Medicare Part B is medical insurance for services like doctor’s appointments and urgent care visits.
Medicare Part D allows you to add prescription drug coverage to original Medicare.
Part D is made up of stand-alone plans offered by private insurance companies. All Part D plans are overseen by Medicare and need to follow Medicare’s regulations.
The Medicare Part D plans available to you will depend on where you live. Some plans, like SilverScript, are available nationwide — but many plans are available only in select states or regions.
How do I find the right Part D plan for me?
You can search for plans in your area that include any prescriptions you currently take by using Medicare’s plan finder tool.
It allows you to enter any prescriptions you take, along with personal information like your ZIP code. You’ll then be matched with plans that include your current prescriptions in their formulary.
Do I have to enroll in a Part D plan?
You’re not required to have a Part D plan if you have Medicare, but you do need to have prescription drug coverage. You’ll pay a late enrollment penalty if you don’t have prescription coverage at all, and the fee increases with each month you don’t have adequate coverage.
Medicare allows you to get this coverage from other sources, such as your employer’s health plan.
You can also get coverage by selecting a Medicare Advantage (Part C) plan that includes Part D coverage. A Medicare Advantage plan that includes Part D allows you to have all your coverage in one plan.
SilverScript offers three different Medicare Part D plans nationwide. SilverScript Choice is available in all 50 states, while SilverScript Plus is available in every state except Alaska.
All plans offer no or low copays for tier 1 generics at preferred pharmacies and for mail-order supplies. With SilverScript, you have access to more than 65,000 pharmacies, as well as many preferred pharmacies.
The SilverScript Plus plan has no deductible and more coverage during the Part D donut hole, while the SilverScript Choice and SilverScript SmartRx plans offer lower monthly premiums.
This article was updated on November 20, 2020, to reflect 2021 Medicare information.