SilverScript Plus is a prescription drug plan available in Rhode Island. This 2018 Medicare Part D plan is approved by the Centers for Medicare and Medicaid Services (CMS) for people with Medicare benefits.
There are five components of every plan that should be evaluated before making an enrollment decision:
- Premium & Deductible: The premium is the amount you pay to be in the plan. This is the monthly cost of membership. In addition, plans may have an annual deductible. This is an amount that you pay towards your prescription costs before cost sharing begins.
- Co-pays & Co-insurance: This is where many people pay more than they should. Prescription co-payments (what you pay at the pharmacy) vary widely based on the formulary tier your drug is in. It's critical to verify that your medications are covered at the lowest tier possible.
- Coverage Phases: All Medicare Part D plans have an initial coverage phase, followed by a coverage gap phase, followed by a catastrophic coverage phase. The phase you're in will largely depend on the cost of your prescriptions. Some plans offer additional coverage in the gap phase. If you have costly medications, look for a plan with additional gap coverage.
- Medication Cost: One of the most challenging aspects of the Medicare Part D program is finding your prescription at the best price. It has as much to do with the pharmacy you use as it does the plan itself. This is because plans have preferred pharmacies and pharmacies have different contracts with pharmaceutical manufactures. Here's a secret, use our friends at GoodRx.com to find your prescription at the best price in your town.
- 5-Star Ratings: Critical measurements, by Medicare, will help you see how well this plan will care for you.
Detailed Cost Information
SilverScript Plus is a cost sharing plan. There are three costs: monthly premiums, an annual deductible, and co-payments or co-insurance.
The annual premium is $765.60 ($63.80 per month), and breaks down like this:
You can't join the SilverScript Plus plan if you have low income subsidy (LIS) benefits.
There is a $0.00 annual deductible with this PDP.
A zero dollar ($0.00) deductible, like this plan has, gives you first dollar coverage. Some PDPs have a deductible (up to $400 per year in 2018) that you must pay out-of-pocket before coverage begins.
Your Out-of-Pocket Costs: Premium + Deductible + Co-pay
You are required to pay your premium each month, even if you don't fill a prescription. Plus, you'll pay all of your prescription costs until the annual deductible amount has been paid (if any). You'll also pay the required copayment at your pharmacy when you have your prescriptions filled. These are your costs and the plan pays the rest.
Your Costs May Be Different
There are two situations that change change what you pay. If you're accepted into the Extra Help program, administered by the Social Security Administration, your premium could be lower. It's also possible that your premium could be higher if you have a late entry penalty because you did not enroll when first eligible.
Details of Plan Coverage
SilverScript Plus is a Enhanced Alternative plan. By law, SilverScript is required to offer a standard benefit package. The standard benefit has an annual deductible, an initial coverage limit, a gap in coverage (donut hole), and a catastrophic coverage phase. Insurance carriers have the option to offer plans that:
- are an actuarial equivalent to the standard benefit; or
- provide enhanced benefits, as compared to the standard benefit.
Most enhanced plans provide additional coverage in the coverage gap phase. If your medications are costly, shop and compare enhanced plans.
Initial Coverage Limit Phase
The ICL is the same for all Rhode Island plans, but it changes from year-to-year. If you enroll in SilverScript Plus you share the cost of all covered medications with SilverScript. You each pay your share until $3750.00 has been spent at the pharmacy. If you reach that level of spending on your prescriptions then you fall into the dreaded coverage gap and you are responsible for all costs. Fortunately, automatic discounts kick in to help you until you qualify for Medicare's catastrophic coverage in Rhode Island.
Coverage Gap Phase
If you reach the coverage gap phase, or donut hole, as many people call it, you are essentially uninsured and must pay for all of your prescription costs out-of-pocket. When you reach the coverage gap with the SilverScript Plus plan will all depend on your prescriptions. Most people never exceed the ICL and don't have to worry about it. If you are on a long-term medication that's costly, you could reach the donut hole very quickly.
In the coverage gap phase you are responsible for the full cost of your prescription drugs up until your total out-of-pocket expenses reach $4,550 (excluding premiums and expense paid by insurance) minus a 47.5% discount on brand-name prescription drugs and a 28% discount on generic drugs. Once you reach $4,550 in out-of-pocket expenses, you're out of the coverage gap. At this point you automatically get catastrophic coverage through Medicare, which assures you only pay a small amount for covered drugs for the remainder of the year.
Enhanced Gap Coverage
SilverScript Plus has limited coverage in the gap coverage phase. Call or review the plan's Summary of Benefits for additional information. If you went into the coverage gap phase last year, and could not afford your medications, call with your local Rhode Island Medicaid office and the Social Security Administration (SSA). The SSA's Extra Help program helps people who can't pay for their prescriptions.
Catastrophic Coverage Phase
When your out-of-pocket spending reached $4,950 (2018 level), you'll automatically get "catastrophic coverage." With catastrophic coverage you'll pay a small co-insurance or co-payment for your covered drugs for the remainder of the year. Medicare and your plan pay the rest of the costs.
Co-payment & Co-insurance Details
In addition to the monthly premium and annual deductible, the SilverScript Plus prescription drug plan has co-payments (fixed dollar amount) and/or co-insurances (percentage) that you must pay when you pickup your medications. Here's the schedule for this plan:
|Tier||You Pay||Tier Description|
CRITICAL: To understand how much you will pay at the pharmacy if you join this plan, you must find the tier of each of your prescriptions in the plan's formulary.
TIP: Use the GoodRx Medicare tools to find your prescription at the best price in your town.
CMS 5-Star Ratings
The annual CMS plan ratings are important. Each year CMS rates PDPs across four categories. Ratings offer a good clue as to the quality of service you can expect if you join the plan.
|2018 Overall Rating|
|Drug Plan Customer Service|
|Complaints and Changes in the Drug Plan|
|Member Experience with the Drug Plan|
|Drug Safety and Accuracy of Drug Pricing|
SilverScript Contact Information
Here's the new member contact information for SilverScript:
For assistance 24 hours a day, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048 or visit www.medicare.gov
If you are entitled to Medicare Part A (enrolled or not) or currently enrolled in Medicare Part B you may join the SilverScript Plus prescription drug plan. Unless you also receive benefits from Medicaid, enrollment in a Part D plan is voluntary. This plan is available in Cranston, Providence, Warwick, Pawtucket, Woonsocket, Coventry, and all other towns and cities in Rhode Island.
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