SilverScript Choice Louisiana Medicare Part D Plan
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| Medicare Rating: | |
|---|---|
| CMS Plan ID: | S5601-042 |
| CMS Plan Year: | 2021 |
| Premium: | $30.60/mo |
| Rx Deductible: | $215.00 (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 Louisiana
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 Choice is a cost-sharing prescription drug plan (PDP). There are three distinct costs: monthly premiums, an annual deductible, and co-payments or co-insurance. The annual premium on this PDP is $367.20 ($30.60 per month), and breaks down as follows:
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% | $7.60 | |
| 50% | $15.30 | |
| 25% | $22.90 |
Deductible
This plan has a $215.00 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
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 Louisiana Medicare Insurance Agent to get an exact quote for your situation.
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
The ICL is the same for all Louisiana plans, but it changes from year-to-year. If you enroll in SilverScript Choice you share the cost of all covered medications with SilverScript. You each pay your share until $4130.00 (retail spending) 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 Louisiana.
Coverage Gap (aka, Donut Hole)
The coverage gap, or donut hole, as it is often called, is the coverage phase where you no longer receive assistance from the plan. In other words, you pay for your prescriptions out-of-pocket. How quickly you reach the coverage gap with SilverScript Choice all depends on your prescriptions. Most seniors never fall into the donut hole.
If you reach the ICL (most people don't), then you are responsible for 100% of your prescription costs until your out-of-pocket costs hit $6,350 (excluding your monthly premiums and the amount paid by the plan). This is called the coverage gap or donut hole. The good news is that you get a 75% discount on your brand-name prescription drugs and your generic medications while you're in the gap. You get to the other side of the donut hole when you've spent $6,350, at which point you automatically qualify to receive catastrophic coverage from Medicare.
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 Louisiana 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 Louisiana 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 Louisiana Medigap plans. It's also compatible with Medicare Part C plans in Louisiana, 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 Choice prescription drug plan. Unless you also receive benefits from Medicaid, enrollment in a Part D plan is voluntary. This plan is available in New Orleans, Metairie, Baton Rouge, Shreveport, Lafayette, Lake Charles, Kenner, Bossier City, Monroe, Alexandria, and all other towns and cities in Louisiana.
The Medicare Part D information on this page originates from CMS Landscape Source Files, is maintained by David Bynon, and was last updated on .
