2020 Plan Decision Guide - Your guide to choosing a Medicare Part D plan - SilverScript
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2020 Plan Decision Guide
Your guide to choosing a Medicare
Part D plan
20-PG-CN
All about prescriptions.
All about you.
Since Medicare Part D began in
2006, we’ve had one focus — to
deliver Medicare prescription drug
coverage that works well every day,
in every way.
2
We specialize in Medicare Part D — so you
don’t have to
Whether you’re new to Medicare Part D or just looking for better drug coverage, we
have plans to fit your health needs and budget. A proud member of the CVS Health®
family, SilverScript is America’s largest Medicare Part D prescription drug plan (PDP)
insurer.1 And unlike some Medicare insurers, PDPs are the only plans we offer. As
you learn more about us, you’ll come to see why more than 6 million1 people with
Medicare count on us to make their prescriptions more affordable.
Better coverage for greater peace of mind
When you enroll with us, you’re joining millions of people with Medicare who enjoy:
Affordable coverage
Choose from plans that offer $0 deductibles on Tiers 1 and 2.
Copays as low as $0 at our preferred pharmacies.2,3
A broad pharmacy network
With more than 65,000 pharmacies, there’s a good chance the
one you use is in our network.
Extensive formularies
Our drug lists include many of the drugs most commonly prescribed to
Medicare members.
24/7 Customer Care
It’s like having your own personal Part D consultant — on call, anytime.
1
CMS, Monthly Enrollment by Plan report, July 2019. http://go.cms.gov/mapddata.
2
Plus plan not offered in Alaska.
3
Available on a 90-day supply in the Initial Coverage Stage through CVS Caremark Mail
Service PharmacyTM. Savings may be lower for those who receive Extra Help.
3
Prescription plans designed
to meet your needs
SilverScript Choice (PDP) SilverScript Plus (PDP)2
Comprehensive coverage with a $0 Provides more robust coverage than the
deductible for drugs on Tiers 1 and 2. Choice plan, including $0 deductible on
Copays as low as $01 at preferred all tiers. Copays as low as $0 at preferred
pharmacies. As our most popular plan, pharmacies in both the initial coverage
Choice might be right for you, too. and gap phases.
You can be confident you’re
covered, coast to coast.
1
Available through the Initial Coverage Stage.
2
Plus plan not offered in Alaska.
4
Get your benefits sooner
With a $0 deductible, your benefits start on day one.
Deductible Copay and coinsurance
Part D plans You pay 100% of drug costs
with a deductible until you reach your deductible.
You pay $0.
SilverScript Plus (PDP)1 We start sharing the cost of your
$0 deductible on all tiers Your plan
prescriptions right away. starts to share
your cost.
You pay $0 on
Tier 1 and 2 drugs.
SilverScript Choice (PDP)2 We start sharing the cost of
$0 deductible on Tiers 1 and 2 your prescriptions after you
meet the deductible.
Plus plan: $0 deductible for all tiers
• With our Plus plan, we start sharing the costs of your drugs the day your plan
takes effect. Other Part D plans can charge you up to $435 before they start
sharing your cost.
• No upfront deductible means you have more consistent monthly expenses,
unless you reach the Medicare Coverage Gap (donut hole).
Choice plan: $0 deductible for Tier 1 and 2 drugs
• With our Choice plan, you don’t pay a deductible for drugs on Tiers 1 and 2 — we
start sharing the cost of those drugs right away.
• You’ll pay our discounted cost for drugs on Tiers 3 to 5. This is only until you reach
the deductible for your plan. Then we’ll share more of the cost going forward.
1
Plus plan not offered in Alaska.
2
Deductible amounts for Tiers 3 through 5 vary by region.
5See your savings, side by side
Prescription drugs can be expensive. Our plans can help you cover the cost. Below is a quick
snapshot to help you compare your options. You’ll find more detailed cost info on the pages
that follow.
Choice Plus1
$0 deductible On Tier 1 and 2 drugs On all tiers
Preferred pharmacies 28,000 23,500
On Tier 12 drugs from a On Tier 13 drugs from a
$0 copay
preferred pharmacy preferred pharmacy
$1 copay at a $2 copay at a
Save on Tier 2 drug copays
preferred pharmacy preferred pharmacy
Coverage in the Medicare Yes, additional coverage
25%
Coverage Gap (donut hole)? on Tier 1 and Tier 2 drugs
Refills by mail are easy
Can’t always get to the pharmacy? We have you covered with CVS Caremark Mail
Service Pharmacy.4 The medicine you take regularly can be delivered by mail. It arrives in
tamper-resistant packaging as you need it, so your medicine is always on hand. Plus, you’ll get
convenient and free standard delivery with a $0 copay on 90-day supplies of your Tier 1 drugs.5
1
Plus plan not offered in Alaska.
2
Available through the Initial Coverage stage.
3
Available through the Coverage Gap.
4
The typical number of business days after the mail-order pharmacy receives an order to receive your
shipment is up to 10 days. Enrollees have the option to sign up for automated mail-order delivery.
5
Available on a 90-day supply in the Initial Coverage Stage through CVS Caremark Mail Service
Pharmacy. Savings may be lower for those who receive Extra Help.
6SilverScript Choice
Comprehensive coverage with a $0 deductible for drugs on Tiers 1 and 2. Copays as low as $0 at
preferred pharmacies.1
ANNUAL DEDUCTIBLE $0 DEDUCTIBLE ON TIER 1 AND TIER 2 DRUGS
INITIAL COVERAGE Your initial coverage stage begins the day your plan takes effect for Tier 1
and Tier 2 drugs. A deductible ranging from $215 to $435 applies to drugs
on Tiers 3, 4 and 5.
YOUR COPAYS ($) AND COINSURANCE (%)
CVS Caremark
Preferred Pharmacy Standard Pharmacy Mail Service Pharmacy
(Preferred)2
Drug tier 30-day 90-day 30-day 90-day 90-day
Tier 1 $0 $0 $53 $15 $0
Tier 2 $1 $3 $64 $18 $3
Tier 3 $47 $141 $47 $141 $141
Tier 4 38%5 38%5 38%5 38%5 38%5
Tier 5 25%–29%6 N/A 25%–29%6 N/A N/A
COVERAGE GAP You leave initial coverage and enter the Medicare coverage gap when you
(DONUT HOLE) reach $4,020 in total yearly drug costs (not including monthly premiums).
Generic drugs You pay 25% of the cost
Brand drugs You pay 25% of the cost
CATASTROPHIC You enter catastrophic coverage when you spend $6,350 out of pocket (not
COVERAGE including monthly premiums).
(AFTER DONUT HOLE)
Generic drugs You pay the greater of 5% coinsurance or $3.40 copay
All other drugs You pay the greater of 5% coinsurance or $8.95 copay
1
Available in the Initial Coverage stage.
2
The typical number of business days after the mail-order pharmacy receives an order to receive your
shipment is up to 10 days. Enrollees have the option to sign up for automated mail-order delivery.
3
$7 for Hawaii Choice.
4
$8 for Hawaii Choice.
5
35% for Hawaii Choice.
6
Coinsurance varies by region.
7SilverScript Plus1
Provides more robust coverage than the Choice plan, including $0 deductible on all tiers. Copays as
low as $0 at preferred pharmacies in both the initial coverage and gap phases.
ANNUAL DEDUCTIBLE $0 DEDUCTIBLE ON ALL TIERS
INITIAL COVERAGE Your initial coverage stage begins the day your plan takes effect.
YOUR COPAYS ($) AND COINSURANCE (%)
CVS Caremark
Preferred Pharmacy Standard Pharmacy Mail Service Pharmacy
(Preferred)2
Drug tier 30-day 90-day 30-day 90-day 90-day
Tier 1 $0 $0 $5 $15 $0
Tier 2 $2 $6 $10 $30 $6
Tier 3 $47 $141 $47 $141 $141
Tier 4 47%–50%3 47%–50%3 47%–50%3 47%–50%3 47%–50%3
Tier 5 33% N/A 33% N/A N/A
COVERAGE GAP You leave initial coverage and enter the Medicare coverage gap when you
(DONUT HOLE) reach $4,020 in total yearly drug costs (not including monthly premiums).
30-day 90-day 30-day 90-day 90-day
Tier 1 $0 $0 $5 $15 $0
Tier 2 $2 $6 $10 $30 $6
Tiers 3, 4 and 5 Generic drugs You pay 25% of the cost
Brand drugs You pay 25% of the cost
CATASTROPHIC You enter catastrophic coverage when you spend $6,350 out of pocket (not
COVERAGE including monthly premiums).
(AFTER DONUT HOLE)
Generic drugs You pay the greater of 5% coinsurance or $3.60 copay
All other drugs You pay the greater of 5% coinsurance or $8.95 copay
1
Plus plan not offered in Alaska.
2
The typical number of business days after the mail-order pharmacy receives an order to receive your
shipment is up to 10 days. Enrollees have the option to sign up for automated mail-order delivery.
3
Coinsurance varies by region.
82020 plan premiums
Keep your budget in a healthy state
No matter where you live, you’ll find a SilverScript plan with Medicare prescription drug coverage that
helps meet your needs. Use the charts below to see costs for the plans in your state.
SilverScript premium costs
Your premium may be lower if you qualify for Extra Help. See page 14 for more information.
Monthly Premium Monthly Premium
Your SilverScript SilverScript Your SilverScript SilverScript
State Choice Plus State Choice Plus
AK $58.20 N/A MT $33.00 $75.30
AL $28.60 $69.80 NC $24.60 $76.40
AR $23.80 $56.70 ND $33.00 $75.30
AZ $30.50 $94.90 NE $33.00 $75.30
CA $30.50 $97.60 NH $30.50 $67.80
CO $29.40 $99.10 NJ $34.90 $101.40
CT $33.10 $89.80 NM $23.30 $79.50
DC $26.90 $80.30 NV $36.30 $76.90
DE $26.90 $80.30 NY $34.80 $91.20
FL $25.20 $78.80 OH $30.80 $76.80
GA $23.30 $70.50 OK $27.60 $72.80
HI $21.20 $86.60 OR $31.30 $85.00
IA $33.00 $75.30 PA $31.80 $83.60
ID $33.70 $84.40 RI $33.10 $89.80
IL $24.90 $89.70 SC $21.60 $77.40
IN $28.90 $68.40 SD $33.00 $75.30
KS $30.40 $71.90 TN $28.60 $69.80
KY $28.90 $68.40 TX $21.20 $77.30
LA $29.00 $84.50 UT $33.70 $84.40
MA $33.10 $89.80 VA $24.70 $65.20
MD $26.90 $80.30 VT $33.10 $89.80
ME $30.50 $67.80 WA $31.30 $85.00
MI $30.20 $62.20 WI $39.20 $69.10
MN $33.00 $75.30 WV $31.80 $83.60
MO $30.90 $65.20 WY $33.00 $75.30
MS $23.90 $69.40
9Part D coverage comparison
See how we compare to your current coverage
Compare your answers in Steps 1 and 2. Are you getting all the value and savings our plans offer?
If not, it may be time to switch.
Step 1: Step 2:
Enter your current plan information Compare SilverScript plans
Your current SilverScript SilverScript
Part D coverage Choice Plus1
ANNUAL DEDUCTIBLE
$ $0 on Tiers 1 and 2 $0 on all tiers
MONTHLY PREMIUM See page 9 for the premium in your state.
$ $ $
Copays/coinsurance
Prescription/amount/ Copays/
Use the Drug Coverage & Pricing tool at
how often you take it coinsurance
silverscript.com to find your costs.
1. $ $ $
2. $ $ $
3. $ $ $
4. $ $ $
65,000+ network 65,000+ network
Is your pharmacy in your NO pharmacies, including pharmacies, including
current plan’s network? YES more than 28,000 more than 23,500
preferred pharmacies preferred pharmacies
NO
24/7 Customer Care YES YES
YES
Plus plan not offered in Alaska.
1
10Medicare and Part D
How they work. And how to make them work better for you.
Medicare is the federal health insurance program for people ages 65 and older and for younger
people who qualify under special circumstances, like those with a disability. Different parts of the
Medicare program cover different costs. Part A is hospital insurance and includes inpatient stays,
skilled nursing and home health care. Part B is medical insurance for doctor services, lab tests,
outpatient care and preventive care. Part D is prescription drug insurance to help you manage
your prescription drug costs.
PART A Important coverage options
HOSPITAL to consider
The right coverage for you depends on your health
needs and budget:
• You can choose Original Medicare by itself
(Parts A and B).
PART B • You can add a Medicare Supplement
MEDICAL (Medigap) plan to help pay for things
not covered by Original Medicare, like
copayments, coinsurance and deductibles.
Plus, you have the freedom to use any
doctor or hospital that accepts Medicare.
KEEP IN MIND: Original Medicare and Medigap plans
don’t include Part D prescription drug coverage.
Complete your coverage
Add a Medicare Part D prescription drug plan to
PART D help you save on prescription drug costs. SilverScript
plans are affordable and comprehensive. And it’s easy
PRESCRIPTION to enroll.
DRUG COVERAGE
11When can I enroll in Medicare Part D?
INITIAL ENROLLMENT PERIOD
TURNING 65: You’re eligible to enroll in Medicare because you’re turning age 65.
You have a seven-month enrollment window that opens three months before your
birthday month and closes three months after your birthday month.1
DISABLED: If you’re under 65, you’re eligible to enroll in Medicare if you have
a qualifying disability. You have a seven-month enrollment window that opens
three months before your 25th month of receiving Social Security or Railroad
Retirement Board benefits and ends three months after.
OR
ANNUAL ENROLLMENT PERIOD
You want to enroll in Medicare Part D or change your existing coverage. It
happens each year between October 15 and December 7.
OR
SPECIAL ENROLLMENT PERIOD
You need to change coverage due to a special circumstance, like moving to a new
home in another state. It can happen any time of the year. Call us for more details.
PLEASE NOTE: MEDICARE PART D HAS A LATE ENROLLMENT PENALTY
You may have to pay this penalty if, at any time after your Initial Enrollment Period
is over, you go without Medicare Part D (or other creditable prescription drug
coverage) for 63 or more days in a row. Medicare will add the penalty amount to
your monthly premium once you enroll in a Part D plan.
To learn more about Medicare enrollment periods, visit
silverscript.com or medicare.gov. Or simply call us at
1-833-526-2210 (TTY: 711). From October 1 to March 31, we’re
here 8 a.m. to 8 p.m., 7 days a week. From April 1 to September 30,
we’re here 8 a.m. to 8 p.m., Monday through Friday.
If your birthday falls on the first day of any month, your seven-month Initial Enrollment Period (IEP)
1
begins and ends one month sooner. For example, if your birthday is July 1, your 7-month IEP is the
same as if you were born in June: It begins in March and ends in September.
12It’s all about quality, reliability and trust
Millions of Medicare beneficiaries choose us year
after year for our coverage, copays, convenience and
customer care.
It’s easy to enroll
Online READY TO GET STARTED?
Be sure to have these items handy when
Visit silverscript.com you’re ready to enroll:
Enrolling online is fast and secure.
And if you have questions at any Your Medicare card
point, simply call us toll-free at the It’s red, white and blue. You can also
number below. refer to the letter you received from either
the Social Security Administration or the
Railroad Retirement Board.
On the phone Other information that may apply to
1-833-526-2210 you or your spouse, including:
(TTY: 711). • Group health plan
information
By mail • Employment information
Complete your application, sign it and • Dates of coverage
seal it in the postage-paid envelope
we provided. Then mail it to: Questions? Just call us at
SilverScript Insurance Company 1-833-526-2210 (TTY: 711).
PO Box 30001
Pittsburgh, PA 15222-0330
We’re dedicated to
Medicare Part D and
your peace of mind.
13Need Extra Help paying
for your prescription
drugs?
If your income is limited, you may qualify for Extra Help to
pay for your medicine. To find out if you qualify, you can:
• Call Social Security at 1-800-772-1213
(TTY: 1-800-325-0778), 7 a.m. to 7 p.m. local time,
Monday through Friday
• Visit socialsecurity.gov
• Contact your local Social Security office
Eligible for Medicare, Medicaid and
Extra Help? You may also qualify for a
$0 monthly premium plan from
SilverScript. Your copays could be
as low as $1.30 with Extra Help.1
You must qualify for Medicare, Medicaid and Extra Help from Medicare to be eligible for $0
1
14
premiums on your prescription drug coverage. Note: $0 premium plans aren’t available in all states.Words to know
Coinsurance: What you pay for covered Deductible: What you pay for covered
prescription drugs after you pay your prescription drugs before your plan starts to pay.
deductible. It’s usually a percentage (for
Formulary: A list of prescription drugs your plan
example, 20 percent).
covers.
Copayment (copay): What you pay for covered
Pharmacy network: A group of pharmacies that
prescription drugs. It’s usually a set amount,
contract with a plan to provide prescription drugs
instead of a percentage (for example, $20).
to its members.
Cost sharing: What you pay for covered
Premium: What you pay each month to your plan
prescription drugs. It can include your
for prescription drug coverage.
copayment, coinsurance and deductible.
The pharmacy network may change at any time. You will receive notice when necessary. Your privacy
is important to us. SilverScript employees are trained regarding the appropriate way to handle your
private health information. SilverScript is a Prescription Drug Plan with a Medicare contract offered by
SilverScript Insurance Company. Enrollment in SilverScript depends on contract renewal. Members
who get “Extra Help” are not required to fill prescriptions at preferred network pharmacies in order to
get Low Income Subsidy (LIS) copays. SilverScript Choice (PDP)’s pharmacy network includes limited
lower-cost, preferred pharmacies in Rural Alaska. The lower costs advertised in our plan materials for
these pharmacies may not be available at the pharmacy you use. For up-to-date information about
our network pharmacies, including whether there are any lower-cost preferred pharmacies in your
area, please call 1-833-526-2210 (TTY: 711), or consult the online pharmacy directory. See Evidence
of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of
coverage. Plan features and availability may vary by service area.
15Thank you for considering SilverScript
Enroll today and soon you’ll find that we do more than provide Medicare Part D coverage.
We offer value, convenience and peace of mind with every prescription.
Ready to enroll or have questions?
Just call us at 1-833-526-2210 (TTY: 711).
Or visit silverscript.com.
©2019 SilverScript® Insurance Company
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