SilverScript Plus Louisiana Medicare Part D Plan

SilverScript Plus is a 3.5 Star Rated Part D Plan for People on Medicare in Louisiana

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 & DeductibleA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share.: 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 limitOnce you have met your yearly deductible, you will pay a copayment or coinsurance for each covered drug until you reach the initial coverage limit. You will then enter your plan’s coverage gap (aka, “donut..., followed by a coverage gapA period of time in which you pay higher cost-sharing for prescription drugs until you spend enough to qualify for catastrophic coverage., 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 is a cost-sharing prescription drug plan (PDP). There are three distinct costs: monthly premiumsA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. , an annual deductible, and co-payments or co-insurance. The annual premium on this PDP is $934.80 ($77.90 per month), and breaks down as follows:

Low-Income Subsidy ("Extra Help")

This plan does not qualify for Extra Help (low-income subsidySocial Security's Low-Income Subsidy (LIS) program helps Medicare beneficiaries pay for their Medicare Part D prescription drugs by paying some of the costs. Also known as "Extra Help", beneficiaries who qualify for LIS receive premium...) 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 $480 per year in 2022) that must be paid before your prescription coverage assistance kicks in.

Your Costs Include the Monthly Premium + Deductible + Copayments

Here's a rundown of your shared costsAn amount patients pay for their share of the cost of medical service or supply, like a doctor’s visit, hospital inpatient visit, or prescription drug.. 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)

Potential Additional Costs

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 MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. Service may impose a premium penalty. Contact your local Louisiana 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.

Most Cost Sharing is in the Initial Coverage Limit Phase

It's important to understand the initial coverage limit (ICL) and how it applies to you in Louisiana. 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 $4430.00 (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.

The Coverage Gap Phase

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 $7,050 (excluding premiums and expense paid by insurance) minus a 75% discount on both brand-name prescription drugs and generics. Once you reach $7,050 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 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 Plus prescription drug plan has copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service. (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 formularyA formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Medications not on a plan's formulary are generally not covered..

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 ServicesThe Centers for Medicare & Medicaid Services (CMS) is the U.S. Federal agency that runs the Medicare, Medicaid, and Children’s Health Insurance Programs. (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 DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... program on www.medicare.gov. For information about the SSA's Extra Help program, download the Understanding Extra Help guide.

Compatibility

This stand-alone Medicare Part D plan is compatible with Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. (hospital insurance) and Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. (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 Plus 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 May 2, 2022 .