SilverScript SmartRx Oklahoma Medicare Part D Plan

SilverScript SmartRx is a 3.5 Star Rated Part D Plan for People on Medicare in Oklahoma

According to 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), 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 & 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 sharingAn 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. 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 SmartRx 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 copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service. and/or coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service.  at your pharmacy.

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 $480.00 deductible (annual).

For 2022, the maximum Part D deductible is $480. 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.

Your Costs Include the Monthly 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 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 Oklahoma Medicare Insurance Agent to get an exact quote for your situation.

Coverage Details

SilverScript SmartRx 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.

The Initial Coverage Limit

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

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 SmartRx all depends on your prescriptions. Most seniors never fall into the donut hole.

When you're in the donut hole you pay all of the costs for your medications, but at a discounted rate (75% off of both brand-name drugs and generics). You continue to pay this until your out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. reach $7,050. At this point, Medicare takes over by giving you catastrophic coverage. The $7,050 out-of-pocket figure does not include your 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.  or what SilverScript pays.

Additional Gap Coverage

SilverScript SmartRx 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 Oklahoma 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 SmartRx 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 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 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 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 Oklahoma Medigap plans. It's also compatible with Medicare Part C plans in Oklahoma, 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 SmartRx prescription drug plan. Unless you also receive benefits from Medicaid, enrollment in a Part D plan is voluntary. This plan is available in Oklahoma City, Tulsa, Norman, Lawton, Broken Arrow, Edmond, Enid, Stillwater, Muskogee, and all other towns and cities in Oklahoma.

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 6, 2022 .