SilverScript Plus New Hampshire Medicare Part D Plan
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| Medicare Rating: | |
|---|---|
| CMS Plan ID: | S5601-003 |
| CMS Plan Year: | 2021 |
| Premium: | $66.80/mo |
| Rx Deductible: | $0.00 (annual) |
| Initial Coverage: | $4130.00 |
| Mail Order: | Coming Soon! |
| Donut Hole Coverage: | Yes |
| Subsidies: | No |
| Formulary ID: | 00020222 |
| Benefit Type: | Enhanced |
SilverScript Plus is a 3.5 Star Medicare Part D Plan for Medicare Beneficiaries in New Hampshire
According to the Centers for Medicare and Medicaid Services (CMS), this prescription drug plan's quality is Average, and rated it 3.5 out of 5.0 stars.
These are the areas of the plan that are important to compare and review:
- Premium & Deductible: The premium is the amount you will pay monthly. Plus, many plans have an annual deductible that must be met before cost sharing begins.
- Coverage Phases: Part D plans have an initial coverage limit, followed by a coverage gap, and then catastropic coverage. Some plans offer some coverage in the gap.
- Co-pays & Co-insurance: If you have regular prescriptions, it's critical to verify that your drugs are covered and to know what you will pay at the pharmacy.
- CMS Ratings: Important measurements across 4 different areas that will help you understand how well this plan will care for you.
Cost Details
SilverScript Plus does not pay all costs; it's a cost-sharing plan. If you join, you share in the overall costs with SilverScript by paying a monthly premium, an annual deductible (if applicable), and copayments and/or coinsurance at your pharmacy.
Low-Income Subsidy
This plan is not available to people receiving full Low Income Subsidy (LIS) benefits.
Deductible
This plan has a $0.00 deductible (annual).
A zero dollar ($0.00) deductible means you have first dollar coverage. Many Part D Plans have a deductible (up to $435 per year in 2021) that must be paid before your prescription coverage assistance kicks in.
You Pay the Premium + Deductible + Copayments
Here's a rundown of your shared costs. Like all other types of insurance, you must pay your premium. The premium has nothing to do with how many prescriptions you have filled. If the plan has a deductible, you must pay one hundred percent of your prescription costs until you reach the amount of the deductible. When the deductible is met, then you pay the copayment amount at the pharmacy. All other costs are paid by the plan until you hit the donut hole (initial coverage limit)
What You Pay Could Be Different
There are two conditions that could affect how much you pay for this plan. If you qualify for the Social Security Extra Help program your premium will generally be lower. Also, if you enrolled late the Centers for Medicare and Medicaid Service may impose a premium penalty. Contact your local New Hampshire Medicare Insurance Agent to get an exact quote for your situation.
Coverage Details
SilverScript Plus is a Enhanced PDP. At a minimum, SilverScript must offer a "standard benefit" package mandated by law. The standard benefit includes an annual deductible and a gap in coverage, aka, donut hole. Carriers may also offer plans that:
- are actuarially equivalent to the standard benefit; or
- are enhanced, offering benefits in addition to the standard benefit.
Typically, enhanced plans offer additional coverage during the coverage gap. If you fell into the donut hole last year, shop enhanced plans.
Initial Coverage Limit
It's important to understand the initial coverage limit (ICL) and how it applies to you in New Hampshire. The ICL is where you share the cost of your prescriptions with the insurance company. You and SilverScript each pay your share until you reach a total of $4130.00 (retail spending) spent at the pharmacy on prescriptions. At that point, you pay all costs yourself because you're in the coverage gap, as explained below.
Coverage Gap (aka, Donut Hole)
When you fall into the coverage gap or donut hole as many people call it, you are basically uninsured and must pay for all of your prescription costs out-of-pocket. When you reach the coverage gap will all depend on your prescriptions. Most seniors 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 $6,350 (excluding premiums and expense paid by insurance) minus a 75% discount on both brand-name prescription drugs and generics. Once you reach $6,350 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.
Additional Gap Coverage
SilverScript Plus offers some additional assistance in the coverage gap. See the plan's Summary of Benefits for details. If you reached the coverage gap last year and were not able to afford your medications, be sure to check with your local New Hampshire Medicaid office. You may qualify for additional assistance. The Social Security Administration's Extra Help program is another opportunity for seniors on Medicare who are not able to afford their prescriptions.
Copayment & Coinsurance Details
In addition to the monthly premium and annual deductible, the SilverScript Plus prescription drug plan has copayments (fixed dollar amount) and/or coinsurances (percentage) that you must pay when you pickup your medications. Here's the schedule for this plan:
IMPORTANT: In order to determine if this is the best PDP for you, it's critical that you look up your prescriptions in the plan's formulary.
Medicare Part D Star Ratings
In this section we show you the quality rating for this plan. Each year the Centers for Medicare and Medicaid Services (CMS) rates prescription drug plans in four broad categories. We do not recommend joining a plan with an overall rating less than 3.0. The following marks will give you an idea of the level of care you will receive if you join this SilverScript plan.
Contact SilverScript
Here's the new member contact information for SilverScript:
For assistance 24 hours a day, call 800-633-4227. TTY users should call 877-486-2048. If you qualify for Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Part D program on www.medicare.gov. For information about the SSA's Extra Help program, download the Understanding Extra Help guide.
Compare Plan Options
The average New Hampshire senior compares three or more plan options before making an enrollment decision.
Compatibility
This stand-alone Medicare Part D plan is compatible with Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), and all New Hampshire Medigap plans. It's also compatible with Medicare Part C plans in New Hampshire, so long as the plan does not include prescription drug coverage.
Availability
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 Manchester, Nashua, Concord, Derry, Dover, Rochester, Salem, Merrimack, Hudson, and all other towns and cities in New Hampshire.
The Medicare Part D information on this page originates from CMS Landscape Source Files, is maintained by David Bynon, and was last updated on .
