Key Differences Between SilverScript Choice and SilverScript Plus Medicare Part D Plans

When reviewing options for Medicare Part D prescription drug coverage, SilverScript is one of the largest national providers. They offer three main plans – SilverScript SmartRx, SilverScript Choice, and SilverScript Plus.

SilverScript Choice and SilverScript Plus have some important differences in terms of costs, coverage, and benefits. Understanding these key distinctions can help you determine which of these two plans aligns best with your prescription needs and budget.

Overview of Medicare Part D

Before diving into the specifics of SilverScript, let’s review some basics about Medicare Part D. This coverage helps pay for prescription medications for those with Original Medicare or Medicare Advantage plans.

Some key facts:

• Private insurers like SilverScript offer Part D plans with varying premiums, deductibles, and drug costs.

• The standard Part D benefit has 4 phases: deductible, initial coverage, coverage gap/donut hole, and catastrophic coverage.

• Costs like copays and coinsurance vary in each phase. Plans have lists of covered drugs known as formularies.

• Higher cost drugs fall into higher tiers, requiring greater cost sharing. Specialty drugs are typically Tier 5.

Part D plans provide critical help with prescription costs, but picking the right one takes some homework. Now let’s see how SilverScript Choice and Plus stack up.

SilverScript Choice Medicare Part D Plan

SilverScript Choice is considered a “benchmark” Part D plan, meaning it offers the standard basic level of coverage outlined by Medicare. Here are some of its main features:

Premiums and Deductibles

• Monthly premiums range from $18.10 to $49.70 depending on your region. Those with very low income may qualify for $0 premium.

• $445 deductible for Tiers 3-5 drugs. $0 for Tiers 1-2.

Initial Coverage Phase

• After deductible, copays for 30-day supply are:

  • Tier 1 (preferred generic): $5 copay

  • Tier 2 (generic): $10 copay

  • Tier 3 (preferred brand): 35% coinsurance

  • Tier 4 (non-preferred): 41% coinsurance

  • Tier 5 (specialty): 27% coinsurance

Coverage Gap Phase

• After total drug costs hit $4,130, you enter the coverage gap. Copays in this phase for 30-day supply are:

  • Tier 1: $5 copay

  • Tier 2: $10 copay

  • Tier 3: 35% coinsurance

  • Tier 4: 41% coinsurance

  • Tier 5: 27% coinsurance

Catastrophic Coverage

• After your true out-of-pocket costs hit $6,550, you pay $3.70 or 5% for generics and $9.20 or 5% for brand name drugs, for the rest of the plan year.

Pharmacies

• Over 65,000 retail pharmacies in network, including CVS, Walgreens, Rite Aid, Walmart, and more.

• Mail order available.

Drawbacks

• No coverage in gap phase for Tiers 3-5. You pay 25% of the full drug cost after reaching $4,130.

• Higherbrand name deductible and coinsurance.

SilverScript Plus Medicare Part D Plan

SilverScript Plus is an enhanced Part D plan with richer benefits compared to the standard Choice plan. Here are some key enhancements:

Premiums and Deductibles

• Monthly premiums range from $52.20 to $88.60 depending on your region.

• $0 deductible for all tiers of covered drugs.

Initial Coverage Phase

• After meeting deductible, 30-day supply copays are:

  • Tier 1 (preferred generic): $0 copay

  • Tier 2 (generic): $2 copay

  • Tier 3 (preferred brand): $47 copay

  • Tier 4 (non-preferred): 50% coinsurance

  • Tier 5 (specialty): 33% coinsurance

Coverage Gap Phase

• Copays in the coverage gap for 30-day supply:

  • Tier 1: $0 copay

  • Tier 2: $2 copay

  • Tier 3: 25% coinsurance

  • Tier 4: 50% coinsurance

  • Tier 5: 33% coinsurance

Catastrophic Coverage

• Same $3.70/$9.20 copays as Choice.

Pharmacies

• Same broad pharmacy network as Choice plan.

Key Benefits

• $0 deductible is less risk of high upfront costs.

• Tier 1 generics have $0 copay in coverage gap, reducing costs.

• Lower Tier 5 specialty coinsurance.

• Additional discounts on certain vitamins and supplements.

Key Differences Between Plans

From this overview, we can highlight some of the major differences between SilverScript’s Choice and Plus Part D plans:

Deductibles

• Choice has a $445 deductible for Tiers 3-5 drugs. Plus has $0 deductible for all tiers.

Copays

• Choice is $5/$10 for Tier 1/Tier 2; Plus is $0/$2 for those tiers.

• Plus offers lower Tier 5 specialty coinsurance.

Coverage Gap

• Plus offers some coverage for Tiers 1-2 in the gap, reducing costs.

• Choice has no tier coverage, so you pay 25% of full cost in gap.

Premiums

• Plus has higher monthly premiums ranging from $52-$88.

• Choice premiums range from $18-$49.

Bottom Line

• Choice has lower premiums but less coverage.

• Plus has richer benefits but higher monthly costs.

Choosing Between SilverScript Plus and Choice

So which SilverScript Medicare Part D plan is better – Choice or Plus? There’s really no one-size-fits-all answer. It depends on your specific prescription needs.

Here are some tips on choosing:

Do you take any Tier 3-5 brand drugs?

The $0 deductible with Plus could provide significant savings if you regularly use non-preferred or specialty medications.

What will your total drug spending be?

If you expect to hit the coverage gap, Plus offers more coverage there. If you don’t, the lower premium with Choice may suffice.

Do you qualify for Extra Help?

If you get Medicare’s Extra Help program for low income beneficiaries, your costs may be reduced with either plan.

Do you take Tier 1 generics?

The $0 copay for these with Plus could add up, especially in the coverage gap.

Can you afford higher monthly costs?

While Plus has richer coverage, the premiums are also higher. Make sure it aligns with your budget.

Which pharmacies do you use?

Both plans have broad pharmacy networks, so your access should be about the same.

Do you want supplemental benefits?

Plus provides additional discounts on vitamins and minerals that Choice does not.

Enrolling in SilverScript Medicare Part D

If you decide either SilverScript Choice or SilverScript Plus is the right plan for your prescription needs, you can enroll during these times:

• Initial Enrollment Period – When you first become eligible for Medicare, you can add a Part D plan during your Initial Enrollment Period.

• Annual Enrollment Period – Every year from October 15 to December 7, you can join, switch or drop a Part D plan for the following year.

• Special Enrollment Period – Life events like moving or losing other creditable coverage may qualify you for a Special Enrollment Period to sign up anytime.

To officially enroll, you can:

• Enroll online directly through SilverScript.

• Enroll by calling 1-855-698-5682 (TTY 711).

• Enroll through the Medicare Plan Finder website.

• Work with a broker or your State Health Insurance Assistance Program (SHIP).

The important thing is to ensure you don’t experience a lapse in prescription coverage. Understanding if SilverScript Choice or Plus better fits your medication needs and budget is a key step in getting the Part D coverage you deserve.

Frequently Asked Questions

Below are answers to some common questions people have when comparing SilverScript Choice vs SilverScript Plus:

Do Choice and Plus have the same pharmacy network?

Yes, both plans give you access to over 65,000 retail pharmacies nationwide, including major chains like CVS, Walgreens, Walmart, and more. You have the same pharmacy options with either plan.

Which has more covered drugs?

The Plus plan formulary covers more drugs across tiers compared to the Choice plan. So your medication is more likely to be included on Plus.

Can I get Extra Help with either plan?

Yes, if you qualify