SilverScript Medicare Part D prescription drug plans are available nationwide. Members have access to more than 65,000 pharmacies across the United States. SilverScript offers three Medicare Part D plan options in 2024.
If you have Medicare Part A and Part B, you may be looking for additional coverage for prescription drugs. SilverScript is a private insurance company that offers Medicare Part D prescription drug plans nationwide.
In this article, we’ll explore the prescription drug benefits offered by SilverScript for 2024, including an overview of its plan options and their costs.
SilverScript is one of the largest providers offering Medicare Part D coverage in the United States, with plans in all 50 states. It became part of Aetna Medicare for the 2024 health plan year.
SilverScript offers three different plans this year, including one with a $0 deductible on all tier 1 drugs. Members have access to a large network of more than 65,000 pharmacies around the country, as well as several thousands of preferred pharmacies for extra discounts.
What do SilverScript drug plans cover?
SilverScript Part D plans have many coverage benefits, including:
- $0 copays for preferred generics
- access to a network of more than 65,000 pharmacies nationwide
- cost savings for 90-day mail-order refills
- formularies that cover nearly all the drugs commonly prescribed to Medicare members
What states offer SilverScript Part D plans?
SilverScript offers three different Part D plans:
- SilverScript SmartSaver
- SilverScript Choice
- SilverScript Plus
All three plans are available to residents of every state.
What are Part D formularies?
All Part D plans have a list of prescription medications they’ll cover. This list is called a formulary.
Your plan’s formulary will divide prescriptions into groups, called tiers. The tiers for prescription plan formularies are typically broken down like this:
- tier 1: preferred generic
- tier 2: generic
- tier 3: preferred
- tier 4: nonpreferred
- tier 5: specialty
Your plan will have a set copay for each tier.
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Here’s some useful information to be aware of for drugs you are already taking or may be prescribed that are not covered by your Medicare plan’s formulary.
Step therapy
Step therapy is when your Medicare drug plan wants you to try other drugs before it covers another (usually more expensive) drug. For example, you must first try treatment with drug X without results before your plan will cover drug Y.
SilverScript does provide a form for step therapy exceptions if, prior to enrolling, you were prescribed a drug that’s not covered.
Prior authorization
For certain drugs, an insurance plan may require you to get prior authorization before coverage is granted. A doctor’s office usually handles this process, which can take several days depending on the case.
The plan must grant approval before the drug is covered, and the plan can deny coverage if it is deemed necessary. Here is the form for requesting prescription drug authorization.
You may also request exceptions for:
- quantity limits (plans may often limit the amount of a medication you can get at a given time)
- reimbursem*nt for covered drugs that you paid for out of pocket
- tiering (plans may move drugs to a higher copay tier at their discretion)
Your doctor’s office handles many of these requests, so you’ll need to talk with your doctor or members of your healthcare team to start these processes.
SilverScript offers prescription drug coverage through three different Medicare Part D plans. Here’s an overview of each option — we’ll dive deeper into price details later in the article.
SilverScript SmartSaver
The SilverScript SmartSaver plan is intended for active, generally healthy adults who take generic maintenance drugs or who do not take any regular medications. It offers $0 copays and a $0 deductible on tier 1 drugs. Plus, nearly 600 drugs on tiers 1 and 2 are available for no more than $5.
SilverScript Choice
With this plan, you may be able to enroll for a $0 premium if you’re enrolled in Medicare’s Extra Help program. You’ll also pay a $2 copay for tier 1 drugs.
SilverScript Plus
The SilverScript Plus plan offers offers a $0 copay and $0 deductible on tier 1 and tier 1 drugs. It also offers $0 copays for a variety of prescription vitamins, minerals, and generic erectile dysfunction drugs.
Coverage phases for Medicare Part D
In 2024, the initial coverage phase for all Part D plans starts from the first dollar you spend on your medications until you reach $5,030 in total yearly drug costs (not including your monthly premium).
After you’ve reached the initial coverage limit, you move into the coverage gap, also known as the donut hole. Different plans will charge you set copay amounts for your medications during this gap phase.
You leave the donut hole and enter the catastrophic coverage phase once you’ve paid $8,000 out of pocket for prescription drug costs for the year. In the catastrophic phase, you’ll pay 5% of the medication cost or $4.50 on covered generics (whichever is greater) and $11.20 on covered brand drugs for the rest of the year.
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Medicare Part D plans can come with a variety of different costs, including deductibles, premiums, copays, coinsurance, and more. Next, we’ll take a look at these costs with SilverScript plans in 2024.
2024 deductibles
Here’s a breakdown of how each plan handles annual deductibles:
- SilverScript SmartSaver: $0 deductible for tier 1 drugs and a $280 deductible for tiers 2 through 5
- SilverScript Choice: $545 deductible for all tiers
- SilverScript Plus: $0 deductible for tiers 1 and 2
2024 premiums
Premiums for SilverScript plans can start as low as $0 if you qualify for Extra Help. If not, here are the average monthly premiums you’ll pay for each plan in 2024:
- SilverScript SmartSaver: $11.19
- SilverScript Choice: $46.59
- SilverScript Plus: $103.51
These rates vary depending on where you live. You can enter your specific ZIP code to search for prices using Medicare’s plan finder tool.
As with all Part D plans, the premium for your SilverScript plan is in addition to the other costs you pay for Medicare.
There’s typically no premium for Part A, but Part B does have a monthly premium. So, if you’re using Original Medicare (parts A and B together), you’ll need to pay the Part B premium and the premium for your SilverScript plan.
If you have a Medigap plan or Medicare Advantage (Part C) plan without Part D coverage, you’ll pay those premiums in addition to that of your Part D plan.
2024 copays
Your medication copays with SilverScript will depend on your plan and on your prescriptions. Here are some of the main differences between the plans:
SilverScript SmartSaver
- Tier 1: $0 copay
- Tier 2: $5 copay for 600 covered drugs
SilverScript Choice
- Tier 1: $2 copay
- Tier 2: $7
SilverScript Plus
- Tier 1: $0
- Tier 2: $0
Questions about any of these plans?
Talk with a licensed Aetna agent at 855-335-1407, Monday through Friday, 8 a.m. to 9 p.m.
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SilverScript offers three different Medicare Part D plans that are available in all 50 states.
All plans offer no or low copays for tier 1 and 2 generic medications. With SilverScript, you have access to more than 65,000 pharmacies.
The SilverScript Plus plan has no deductible and more coverage during the Part D donut hole, while the SilverScript Choice and SilverScript SmartSaver plans offer lower monthly premiums.
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