SilverScript Choice Virginia Medicare Part D Plan
This page contains editorial content that is not endorsed or approved by SilverScript[2]. This is not a solicitation of insurance.
| Medicare Rating: | |
|---|---|
| CMS Plan ID: | S5601-014 |
| CMS Plan Year: | 2021 |
| Premium: | $26.70/mo |
| Rx Deductible: | $380.00 (annual) |
| Initial Coverage: | $4130.00 |
| Mail Order: | Coming Soon! |
| Donut Hole Coverage: | No |
| Subsidies: | Yes |
| Formulary ID: | 00020224 |
| Benefit Type: | Basic |
SilverScript Choice is a 3.5 Star Medicare Part D Plan for Medicare Beneficiaries in Virginia
CMS gave this prescription drug plan a quality rating of 3.5 out of 5.0 stars (Average).
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 Choice 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 qualifies for the full, low income subsidy benefit. The following table details subsidised premium amounts:
| Subsidy Level | Monthly Premium | |
|---|---|---|
| 100% | $0.00 | |
| 75% | $0.00 | |
| 50% | $0.00 | |
| 25% | $0.00 |
Deductible
This plan has a $380.00 deductible (annual).
For 2021, the maximum Part D deductible is $435. A plan with the maximum deductible does not necessarily mean that it is more expensive than a plan with a lower deductible or no deductible at all. You need to consider all costs.
You Pay the Premium + Deductible + Copayments
Be aware that you must continue to pay your monthly premium even when you are not using any medications. Also, it's important to plan ahead because you are responsible for one hundred percent of your prescription costs until the plan's deductible has been met. You also make the required copayment when you pick up your prescriptions. These are your share of the prescription drug costs. The plan pays the rest until you reach the coverage gap (aka, “donut hole”).
What You Pay Could Be Different
Most people pay the standard premium. However, if you qualify for Extra Help with your Medicare Part D plan due to your income, your premium may be lower or cost you nothing at all. But, if you did not enroll in a Part D plan as soon as you were first eligible, Medicare can impose a penalty and your premium will be higher. To get an exact rate for your situation, contact a Virginia Medicare Insurance Agent.
Coverage Details
SilverScript Choice is a Basic 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
Confused about the initial coverage limit? Don't be, because it's straight forward. If you enroll in the SilverScript Choice PDP, you share the cost of your prescriptions with SilverScript. You each pay your share until the amount spent at the pharmacy reaches $4130.00 (retail spending amount). That's the initial coverage limit in Virginia for plan year 2021. After that, you are not covered (coverage gap) until your actual out-of-pocket costs qualify you for catastrophic coverage. Keep reading, because you are entitled to automatic discounts.
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 Choice does not offer additional assistance in the coverage gap. If you reached the coverage gap last year and were not able to afford your medications, be sure to check with your local Virginia 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 Choice 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 Virginia senior compares three or more plan options before making an enrollment decision.
Compatibility
This stand-alone Medicare prescription drug plan is compatible with traditional Medicare (Part A and Part B), and all Virginia Medicare supplement plans. It is also compatible with Medicare Advantage plans in Virginia, so long as the plan does not include Part D.
Availability
If you are entitled to Medicare Part A (enrolled or not) or currently enrolled in Medicare Part B you may join the SilverScript Choice prescription drug plan. Unless you also receive benefits from Medicaid, enrollment in a Part D plan is voluntary. This plan is available in Virginia Beach, Norfolk, Chesapeake, Richmond, Newport News, Alexandria, Hampton, Roanoke, Portsmouth, Suffolk, Lynchburg, Harrisonburg, Charlottesville, Danville, Manassas, and all other towns and cities in Virginia.
The Medicare Part D information on this page originates from CMS Landscape Source Files, is maintained by David Bynon, and was last updated on .
