What is Medicare Silverscript?

What is Medicare Silverscript? text overlaying image of a medication bottle with pills spilling out of itEven if you have Medicare Parts A and B coverage, you may still need extra coverage for your prescription drugs. So, like a lot of people with Medicare, you might be looking at Medicare Part D, especially Medicare Silverscript, which is the cheapest way to cover prescription drugs on the market. It’s not surprising that many Medicare recipients are choosing a Silverscript plan as a way to save money. Could one fit your needs?

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Medicare Part D

Part D of Medicare is the plan for prescription drugs. Some of a Medicare recipient’s medicine costs are covered by these drug plans. Medication costs can add up quickly, and if you don’t have insurance, you may have to pay a lot out of pocket. Medicare Part D plans help pay for the prices of prescription drugs so that people who need them can get them. 

 

Medicare is made up of different parts, or sections, that cover different types of health care. Part A and Part B are the parts of Original Medicare. Prescription drugs are not covered by either of these plans. On the other hand, there are Medicare Advantage Plans, also called Medicare Part C, that are given by private insurance companies. Some of these plans may cover Part D, but not all of them do. If someone with Original Medicare or a Medicare Advantage Plan without a Part D plan wants coverage for prescription drugs, they would need to sign up for a different Medicare Part D plan, like SilverScript.

SilverScript

SilverScript is a private insurance company that merged with Aetna in January of 2020 and offers Medicare Part D plans. It covers prescription drugs for people with Original Medicare. Coverage choices are available in all 50 states and Washington, D.C. People who are qualified for Medicare Part D can choose from three different plans from SilverScript. Each plan has a different fee and covers prescription drugs in a different way. To figure out which plan is best for you, you should make a list of the prescription drugs you take and compare it to the formularies of each plan.

 

Depending on the plan you choose and the medicines you need, SilverScript’s Medicare Part D plans offer a range of fees and copays that can fit almost any budget. Also, these plans cover you at thousands of pharmacies across the country. Even though the SilverScript formulary changes every year, this provider’s prescription drug plans offer full coverage and reasonable prices.

SilverScript Drug Formularies

A formulary is a list of all the prescription drugs that a certain insurance will pay for. When looking for coverage for your prescription drugs, you should know what drugs you take and how the Medicare Part D plans in your area cover them. So, you can sign up for a plan that will cover your medicines. There are times when a Medicare Part D plan might not cover the medicine you need. There could be a formulaic option, though. Your doctor may think about a change if they think it would be a good idea. If not, you could ask for a list exception, which means that the plan may cover your drug if it is approved.

 

SilverScript may change its formularies from time to time, so it’s important to check your prescription drug benefits every year during the Annual Enrollment Period. This will make sure that you get the right coverage every year. There are five tiers of drugs, and each tier may have its own fees or copayments for coverage. Here’s how the tiers are broken up:

 

  • Tier 1 – Commonly prescribed preferred generic drugs
  • Tier 2 – Generic drugs that usually cost more than tier 1 drugs
  • Tier 3 – Preferred brand-name drugs with no generic version
  • Tier 4 – Less commonly prescribed non-preferred drugs
  • Tier 5 – Expensive specialty drugs that may require monitoring

In the formulary you will also see information about any restrictions or terms for coverage that apply to each drug. These rules are listed at the beginning of the formulary. They can include things like needing Aetna’s authorization first or limits on how many drugs can be covered at once. There’s a chance that a SilverScript formulary might be a little different based on where the plan is sold.

SilverScript Plans

There are three different SilverScript coverage choices for Medicare beneficiaries:

SilverScript SmartSaver

This choice is for people who are active, prefer generic drugs, and are generally healthy. It has the lowest national average of monthly premiums at $5.92. It includes $0 deductibles for Tier 1 drugs, and $505 deductible for Tiers 2-5. The copays for preferred pharmacies by tier are:

 

  • Tier 1 – $2 copay for 30-day prescriptions and $6 for 90-day prescriptions
  • Tier 2 – $15 for 30-days’ worth and $45 for 90-days
  • Tier 3 – 25% coinsurance 
  • Tier 4 – 50% coinsurance
  • Tier 5 – 25% coinsurance for 30-day prescriptions

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SilverScript Choice

This plan covers more than the SmartSaver plan, but it has a $505 deductible and a $33.60 monthly premium. If you qualify for the Extra Help program, you can get a $0 monthly premium instead. The copays for preferred pharmacies are:

 

  • Tier 1 – $2 copay for 30-day prescriptions and $6 for 90-day prescriptions
  • Tier 2 – $7 for 30-days’ worth and $21 for 90-days
  • Tier 3 – 17% coinsurance for a 30-day supply; 22% for 90
  • Tier 4 – 30%-40% coinsurance
  • Tier 5 – 25% coinsurance for 30-day prescriptions

SilverScript Plus

This plan has even better coverage than the first 2, with a $75.58 monthly fee, a $0 deductible on all tiers, and a coverage gap for Tier 1 and 2 drugs. I also has$0 copays on Tier 1 and 2 drugs for the other tiers the copays are:

 

  • Tier 3 – $47 copay for a 30 day supply; $141 for 90
  • Tier 4 – 50%-40% coinsurance for both supply amounts
  • Tier 5 – 33% coinsurance for 30-day prescriptions

What Pharmacies Accept SilverScript?

SilverScript lets you get your prescription drugs from thousands of pharmacies across the country. There are more than 65,000 pharmacies in the United States that are part of the SilverScript drugstore network. Your SilverScript Medicare Part D plan will be accepted at most chain pharmacies. But not all shops are in the “preferred category”. With a preferred pharmacy, you can get the drugs for the least amount of money. These pharmacies include:

 

  • Walmart
  • CVS
  • Wegmans
  • Kroger
  • Publix

Even though they cost a little more than preferred pharmacies, standard network pharmacies still offer service. These pharmacies include:

  • Walgreens (for most SilverScript plans)
  • Sam’s Club

There are also many local pharmacies that fall into either of those categories so be sure to check your plan for your area’s local pharmacies.

How To Choose

There are a few things to think about when choosing the right Part D plan, whether it’s SilverScript or any other plan, for you. The major things you should think about are cost, coverage, and how flexible the plan is. Cost is always a factor when choosing a Part D plan. Different plans come with different costs. Coverage gaps, fees, deductibles, copayments or coinsurance, and premiums all affect your overall cost. If you are in good health and prefer to take generic drugs, you may want to choose a plan with a lower premium and benefits for tier 1 or tier 2 drugs. You can choose a plan with a higher cost and more benefits to help with your health care needs if you need specific drugs, have serious health problems, or need more specific coverage.

 

You also need to know how much coverage you need. If you don’t need a lot of coverage, you may want to save money by getting a plan with less coverage. But if you need more coverage because of your health or for your own peace of mind, you may want to look into plans with more coverage that cost more. Choosing the best Part D plan will also depend on how flexible you are about the drugs and pharmacies you want to use. If you don’t mind taking generic or recommended generic drugs, you may have more plan choices. Also, if you are willing to get your drugs from different pharmacies you will have more plans to choose from. However, if you have specific drug plans or pharmacies in mind, you may need to look at better coverage plans to see what works best for you. 

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If you want to compare SilverScript drug plans, you should think about the prescription drugs you take and how much of them you take. You should also think about how much you are willing to pay for premiums and a yearly deductible. As we’ve already said, if the cost of your medicines is getting too high for you, a SilverScript plan could help you by putting all of your monthly costs into one payment. 

 

You should also look into a Medicare Supplement Plan if you want to save even more money. There are 10 Medicare Supplement Plans to choose from, and each one has different rates and coverage choices. Talk to an EZ agent about all of your choices. The agents at EZ work with the best insurance companies in the country, and they can review plans for you for free in just a few minutes. Enter your zip code in the box below to get free instant quotes for plans that cover your present doctors, or call 877-670-3602 to talk to a licensed agent.

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About The Author:
Cassandra Love

With over a decade of helpful content experience Cassandra has dedicated her career to making sure people have access to relevant, easy to understand, and valuable information. After realizing a huge knowledge gap Cassandra spent years researching and working with health insurance companies to create accessible guides and articles to walk anyone through every aspect of the insurance process.

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