2019 Plan Decision Guide Your guide to making an informed Medicare Part D choice

Transcription

1 2019 Plan Decision Guide Your guide to making an informed Medicare Part D choice SilverScript is a Prescription Drug Plan with a Medicare contract offered by SilverScript Insurance Company. Enrollment in SilverScript depends on contract renewal. Y0080_12008_ACQ_2019_v2_M Accepted 19-PG-CN

2 All about prescriptions. All about you. Since Medicare Part D began in 2006, SilverScript (PDP) has had one focus to deliver Medicare prescription drug coverage that works well every day, in every way. 2

3 Specializing in Medicare Part D so you don t have to. Whether you re new to Medicare Part D or are looking for better drug coverage for your current prescription needs, SilverScript has plans to fit your lifestyle and your budget. Unlike some Medicare insurers, Part D is the only coverage we offer. That s why SilverScript is your prescription for peace of mind. As you learn more about us, you ll understand why more than 6 million people with Medicare count on SilverScript to make their prescriptions more affordable. Making prescription drug coverage better. A proud member of the CVS Health family, SilverScript is America s largest 1 Medicare Part D prescription drug plan insurer. When you enroll with us, you re joining millions of people with Medicare who enjoy: Affordable coverage low copays and coinsurance, plus a $0 annual deductible on all drugs. 2 Broad pharmacy network With more than 66,000 pharmacies, there s a good chance the pharmacy you use is in our network. 24/7 Customer Care our commitment to always go the extra mile to ensure you find the peace of mind you re looking for. Supporting Medicare beneficiaries for more than 12 years. SilverScript has been an approved sponsor of the Medicare Part D program since it began. With more than a decade of experience, SilverScript continues to work within the Medicare system to help people from all walks of life benefit from their Part D coverage. LET S SEE HOW SILVERSCRIPT WORKS FOR YOU FOR COST, COVERAGE AND CONVENIENCE 3

4 Prescription plans designed to meet your needs. SilverScript Choice (PDP) Comprehensive coverage with low copays, our lowest premiums, a nationwide network and savings at preferred pharmacies 3. As our most popular plan, Choice might be the right plan for you too. SilverScript Plus (PDP) 4 Benefits in the Medicare coverage gap, even lower copays, and greater savings at preferred pharmacies. SilverScript Allure (PDP) 4 Peace of mind and help managing your drug costs with lower out-of-pocket costs on many brand name drugs. You can be confident you re covered, coast to coast. 4

5 Why SilverScript may make sense for you. Finding the right Medicare Part D plan isn t always easy. But you ve done your research and looked at many coverage options. Now it s time to choose the plan that works best for your needs and your budget. It s time for SilverScript 27,000 3,400 24/7 $0 or more preferred network pharmacies 3, helping you maximize your savings. Medicare prescription drugs brand name, generic and specialty. Customer Care. Like having your own personal Part D consultant, on call, anytime! annual deductible. 2 We start sharing costs with you on your very first prescription. More ways we re looking out to protect your health and savings. Low premiums with SilverScript Choice starting as low as $23.20 a month (see page 7 for your state). Save up to 50% or more with lower copays at preferred pharmacies, including thousands of chain, regional and independent pharmacies. 5 $0 copays 6 from CVS Caremark Mail Service Pharmacy TM7 for 90-day supplies of Tier 1 medications with Choice and Allure and on Tier 1 and 2 medications with Plus. Added 16% savings 8 with CVS Caremark Mail Service Pharmacy for 90-day supplies of medications on Tier 2, Tier 3, or both, depending on the plan. 66,000 pharmacies and counting Use any of our standard network pharmacies nationwide, whether you are at home or traveling, including CVS Pharmacy, Walgreens, Walmart, Rite Aid and many more. NOW, LET S SEE WHICH PLAN IS RIGHT FOR YOU Easy ways to enroll or learn more: Visit SilverScript.com or Medicare.gov Call us toll free at (TTY: 711) 24 hours a day, 7 days a week. 5

6 Get your benefits sooner. With a $0 deductible, your benefits start on day one. * Part D Plans with a deductible $0 deductible on all tiers Deductible You pay 100% of drug costs until you reach your deductible. You pay $0 2 SilverScript immediately starts to share the cost of your prescriptions. *Not all states have a $0 deductible. See chart below for your state s deductible. Copay & Coinsurance Your plan starts to share your cost. How does a $0 deductible help me? The Part D plan starts sharing the costs of your drugs on the first day of your plan. Other Part D plans can charge you up to $415 before they start sharing your cost. No upfront deductible means you have more consistent monthly expenses, unless you reach the coverage gap (donut hole). What if the $0 deductible covers only Tier 1 and 2 drugs? You don t pay a deductible for drugs on Tiers 1 and 2; SilverScript starts sharing the cost of those drugs right away. You still have more consistent monthly expenses, but it s based on whether the drugs you take are on Tier 1 or 2 or higher. For any drugs you may take on Tiers 3-5, you pay the amount of the deductible before SilverScript starts paying its share. See the chart below for state specifics. What drug tiers does the Choice plan $0 deductible cover in my state? Find your state in the list below. If you don t see your state, your $0 deductible applies to all drug tiers in Tier 1 and 2 drugs Tier 3, 4 and 5 drugs Colorado, Georgia, Texas $0 $100 Arizona, South Carolina $0 $415 Alaska All other states $415 (all tiers) $0 (all tiers) 6

7 2019 plan premiums To keep your budget in a healthy state. No matter where you live, you ll find a SilverScript plan with Medicare prescription drug coverage that helps meet your needs. Use the charts below to see how affordable SilverScript is in your state this year. SilverScript Premium Costs Your premium may be lower if you qualify for Extra Help. See page 16 for more information. Your State Monthly Premium SilverScript SilverScript Choice Plus SilverScript Allure AK $49.50 N/A N/A AL $29.60 $49.50 $80.00 AR $23.20 $51.60 $79.90 AZ $31.20 $79.50 $80.00 CA $34.80 $83.60 $80.00 CO $32.20 $78.70 $79.90 CT $34.20 $65.50 $80.00 DC $30.70 $69.30 $80.00 DE $30.70 $69.30 $80.00 FL $28.00 $73.80 $80.00 GA $25.20 $50.90 $80.00 HI $24.50 $62.80 $80.00 IA $32.30 $68.20 $80.00 ID $36.10 $71.70 $80.00 IL $26.80 $83.40 $80.00 IN $29.10 $52.10 $80.00 KS $32.10 $66.60 $80.00 KY $29.10 $52.10 $80.00 LA $31.50 $60.70 $80.00 MA $34.20 $65.50 $80.00 MD $30.70 $69.30 $80.00 ME $32.00 $53.80 $80.00 MI $30.80 $46.70 $80.00 MN $32.30 $68.20 $80.00 MO $30.00 $51.40 $80.00 Your State Monthly Premium SilverScript SilverScript Choice Plus SilverScript Allure MS $26.90 $50.60 $80.00 MT $32.30 $68.20 $80.00 NC $29.70 $61.20 $80.00 ND $32.30 $68.20 $80.00 NE $32.30 $68.20 $80.00 NH $32.00 $53.80 $80.00 NJ $35.20 $85.20 $80.00 NM $24.20 $44.10 $80.00 NV $38.40 $65.30 $80.00 NY $37.90 $73.80 $80.00 OH $31.90 $50.10 $80.00 OK $30.20 $66.50 $80.00 OR $32.50 $65.80 $80.00 PA $32.50 $59.10 $80.00 RI $34.20 $65.50 $80.00 SC $23.50 $52.20 $80.00 SD $32.30 $68.20 $80.00 TN $29.60 $49.50 $80.00 TX $24.50 $51.60 $80.00 UT $36.10 $71.70 $80.00 VA $29.20 $50.40 $80.00 VT $34.20 $65.50 $80.00 WA $32.50 $65.80 $80.00 WI $36.30 $60.40 $80.00 WV $32.50 $59.10 $80.00 WY $32.30 $68.20 $

8 Three comprehensive Part D plans. Designed to protect your health and your savings. SilverScript Choice You get low premiums, low copays, additional savings at preferred pharmacies and the convenience of a nationwide pharmacy network. ANNUAL DEDUCTIBLE $0 DEDUCTIBLE* INITIAL COVERAGE SilverScript Choice is a $0 deductible plan, meaning your initial coverage stage begins the day your plan takes effect. YOUR COPAYS ($) AND COINSURANCE (%) Preferred Pharmacy 3 Standard Pharmacy CVS Caremark Mail Service Pharmacy 7 Preferred Standard drug tiers 30-day 90-day 30-day 90-day 90-day 90-day Tier 1 $3 $9 $9 $27 $7 $10 $21 $30 $0 $21 $30 Tier 2 $10 $19 $30 $57 $19 or $20 $57 or $60 $25 $47.50 $57 or $60 Tier 3 $34 $46 $102 $138 $46 or $47 $138 or $141 $85 $115 $138 or $141 Tier 4 34% 49% 34% 49% 49% or 50% 49% or 50% 34% 49% 49% or 50% Tier 5 33% N/A 33% N/A N/A N/A COVERAGE GAP (DONUT HOLE) CATASTROPHIC COVERAGE (AFTER DONUT HOLE) You leave initial coverage and enter the Medicare coverage gap when you reach $3,820 in total yearly drug costs (not including monthly premiums). Generic drugs Brand drugs You pay 37% of the cost You pay 25% of the cost You enter catastrophic coverage when you spend $5,100 out of pocket (not including monthly premiums). Generic drugs You pay the greater of 5% coinsurance or $3.40 copay All other drugs You pay the greater of 5% coinsurance or $8.50 copay *Alaska Choice plan has a $415 deductible and copays/coinsurance of $1/$4/18%/37%/25% (Tiers 1-5). Arizona and South Carolina Choice plans have a $415 deductible (Tiers 3-5), preferred copays/coinsurance of $1/$5/$19 or $20/34% or 35%/25% (Tiers 1-5), and standard copays/coinsurance of $6/$14 or $15/$34 or $35/39% or 40%/25% (Tiers 1-5). Colorado, Georgia and Texas Choice plans have a $100 deductible (Tiers 3-5), preferred copays/coinsurance of $3/$13 or $14/$42 or $43/42% or 47%/31% (Tiers 1-5), and standard copays/coinsurance of $7/$20/$47/50%/31% (Tiers 1-5). 8

9 Two plans with enhanced benefits. So you can choose what works best. SilverScript Plus * You get additional benefits in the Medicare coverage gap, even lower copays than Choice, and greater savings at preferred pharmacies. ANNUAL DEDUCTIBLE $0 DEDUCTIBLE INITIAL COVERAGE SilverScript Plus is a $0 deductible plan, meaning your initial coverage stage begins the day your plan takes effect. YOUR COPAYS ($) AND COINSURANCE (%) Preferred Pharmacy Standard Pharmacy CVS Caremark Mail Service Pharmacy 7 Preferred Standard drug tiers 30-day 90-day 30-day 90-day 90-day 90-day Tier 1 $1 $3 $10 $30 $0 $30 Tier 2 $5 or $10 $15 or $30 $20 $60 $0 $60 Tier 3 $31, $33, $35, or $42 $93, $99, $105, or $126 $47 $141 $77.50, $82.50, $87.50, or $105 Tier 4 40% 40% 50% 50% 40% 50% Tier 5 33% N/A 33% N/A N/A N/A $141 COVERAGE GAP (DONUT HOLE) Tier 1 Tier 2 You leave initial coverage and enter the Medicare coverage gap when you reach $3,820 in total yearly drug costs (not including monthly premiums). 30-day 90-day 30-day 90-day 90-day 90-day $1 $3 $10 $30 $0 $30 $5 or $10 $15 or $30 $20 $60 $0 $60 Tiers 3, 4 and 5 Generic drugs You pay 37% of the cost Brand drugs You pay 25% of the cost CATASTROPHIC COVERAGE (AFTER DONUT HOLE) You enter catastrophic coverage when you spend $5,100 out of pocket (not including monthly premiums). Generic drugs You pay the greater of 5% coinsurance or $3.40 copay All other drugs You pay the greater of 5% coinsurance or $8.50 copay *Plus plan not available in Alaska. 9

10 Savings on brand name drugs. At retail and mail service pharmacies. SilverScript Allure * You ll have peace of mind and appreciate help managing your drug costs with lower out-of-pocket costs on many/most brand name drugs. ANNUAL DEDUCTIBLE $0 DEDUCTIBLE INITIAL COVERAGE SilverScript Allure is a $0 deductible plan, meaning your initial coverage stage begins the day your plan takes effect. YOUR COPAYS ($) AND COINSURANCE (%) Preferred Pharmacy Standard Pharmacy CVS Caremark Mail Service Pharmacy 7 Preferred Standard drug tiers 30-day 90-day 30-day 90-day 90-day 90-day Tier 1 $1 $3 $10 $30 $0 $30 Tier 2 $5 $15 $20 $60 $12.50 $60 Tier 3 20% 20% 25% 25% 20% 25% Tier 4 40% 40% 50% 50% 40% 50% Tier 5 33% N/A 33% N/A N/A N/A COVERAGE GAP (DONUT HOLE) CATASTROPHIC COVERAGE (AFTER DONUT HOLE) You leave initial coverage and enter the Medicare coverage gap when you reach $3,820 in total yearly drug costs (not including monthly premiums). Generic drugs Brand drugs You pay 37% of the cost You pay 25% of the cost You enter catastrophic coverage when you spend $5,100 out of pocket (not including monthly premiums). Generic drugs All other drugs You pay the greater of 5% coinsurance or $3.40 copay You pay the greater of 5% coinsurance or $8.50 copay *Allure plan not available in Alaska. 10

11 Discover the plan that s right for you. See their savings side-by-side SilverScript plans help our members save on prescription costs. But what s most important to you? See the savings they offer you, side by side. Choice Plus 4 Allure 4 $0 deductible Yes, on all drugs 2 Yes, on all drugs Yes, on all drugs Preferred pharmacies 3 27, , ,000+ Savings 5 with preferred copays Up to 50% or more Up to 80% or more Up to 80% or more $0 copays 6 with mail service Tier 1 drugs Tier 1 and 2 drugs Tier 1 drugs 16% savings 8 with mail service Tier 2 and 3 drugs* Tier 3 drugs Tier 2 drugs Refills by mail are easy! Can t always get to the pharmacy? We have you covered with CVS Caremark Mail Service Pharmacy. 7 The medications you take regularly can be delivered by mail. They arrive in tamper-resistant packaging as you need them so that your medications are always on hand. And don t worry, standard deliveries are no cost to SilverScript members. NOW IT S TIME TO COMPARE COVERAGE *Alaska Choice plan: Tier 2 drugs 11

12 Part D Coverage Comparison See how SilverScript compares to your current coverage. Compare your answers in Steps 1 and 2. Are you getting all the value and savings that a SilverScript Part D plan offers you? If not, it s time to switch to a $0 deductible 2 SilverScript plan and start saving! Step 1: Enter plan information Step 2: Compare SilverScript plans ANNUAL DEDUCTIBLE Your current Part D coverage SilverScript Choice SilverScript Plus 4 SilverScript Allure 4 $ $0 2 $0 $0 MONTHLY PREMIUM See page 7 for the premium in your state. $ $ $ $ Prescription / Dosage / Frequency Copays / Coinsurance Copays / Coinsurance Use the Drug Search and Pricing tool on SilverScript.com to find your costs. 1. $ $ $ $ 2. $ $ $ $ 3. $ $ $ $ 4. $ $ $ $ Local pharmacy in network NO YES 66,000+ network pharmacies, including more than 27,000 preferred locations 3 66,000+ network pharmacies, including more than 35,000 preferred locations 66,000+ network pharmacies, including more than 35,000 preferred locations 24/7 Customer Care NO YES YES YES YES 12

13 Medicare and Part D. How they work. And how to make them work better for you. Medicare is the federal health insurance program for people ages 65 and older, and younger individuals who qualify under special circumstances, like those with a disability. Different parts of the Medicare program cover different costs. Part A is hospital insurance and includes inpatient stays, skilled nursing and home healthcare. Part B is medical insurance for doctor services, lab tests, outpatient and preventive care. And Part D is prescription drug insurance to help you manage your prescription drug costs. PART A HOSPITAL PART B MEDICAL PART D PRESCRIPTION DRUG COVERAGE Important coverage options to consider The right coverage for you depends on your health needs and your budget You can choose Original Medicare by itself (Parts A and B). You can add a Medicare Supplement (Medigap) plan to help pay for things not covered by Original Medicare, like copayments, coinsurance and deductibles. Plus, get the freedom to use any doctor or hospital that accepts Medicare. KEEP IN MIND: Original Medicare and Medigap plans do not include Part D prescription drug coverage. Complete your coverage Add a Medicare Part D prescription drug plan like SilverScript to help save on your prescription drug costs. Our plans are affordable and comprehensive, and it s easy to enroll. 13

14 When can I enroll in Medicare Part D? INITIAL ENROLLMENT PERIOD TURNING 65: You re eligible to enroll in Medicare because you re turning age 65. It s a seven-month window that opens three months before your birthday month and closes three months after your birthday month. 9 DISABLED: If you re under 65, you are eligible to enroll in Medicare if you have a qualifying disability. You will have a seven-month enrollment window that opens three months before the 25th month of receiving your Social Security or Railroad Retirement Board benefits and ends three months later. ANNUAL ENROLLMENT PERIOD You want to enroll in Medicare Part D or change existing coverage. It happens each year between October 15 and December 7. SPECIAL ENROLLMENT PERIOD OR OR You need to change coverage due to a special circumstance, like moving to a new home in another state. It can happen any time of the year. Call us for more details. PLEASE NOTE: MEDICARE PART D HAS A LATE ENROLLMENT PENALTY. You may owe a Part D Late Enrollment Penalty if, at any time after your initial enrollment period is over, there s a time period of 63 or more days in a row when you don t have Part D or other creditable prescription drug coverage (e.g., prescription drug coverage through an employer or union health plan). Medicare will add a recurring Part D Late Enrollment Penalty to your monthly premium once you enroll in a Part D plan. Easy ways to enroll or learn more: Visit SilverScript.com or Medicare.gov Call us toll free at (TTY: 711) 24 hours a day, 7 days a week. 14

15 All about quality, reliability and trust. Millions of Medicare beneficiaries choose SilverScript year after year for the coverage, copays, convenience and customer care. All about making it easy for you to enroll. Online Go to SilverScript.com It s fast and secure! If you have questions while enrolling online, feel free to call the toll-free number for assistance. Call (TTY: 711) 24 hours a day, 7 days a week. Customer Care representatives are ready to help you. By Mail Complete your application, sign it, and enclose it in the postage-paid envelope provided. Mail to: SilverScript Insurance Company PO Box Pittsburgh, PA ENROLLMENT HELP To make things easier for you, have these items close by when you re ready to enroll: YOUR MEDICARE CARD It s red, white and blue. You can also refer to the letter you received from either the Social Security Administration or the Railroad Retirement Board. YOUR MEDICAID NUMBER (if you receive Medicaid benefits) ADDITIONAL INFORMATION THAT MAY APPLY TO YOU OR YOUR SPOUSE, INCLUDING: Group health plan information Employment information Dates of coverage If you need assistance, call SilverScript Customer Care at (TTY: 711). We re here to help anytime, day or night. Dedicated to Medicare Part D and your peace of mind. 15

16 Do you need Extra Help paying for a Medicare plan? People with limited resources and incomes can get Extra Help from Medicare to pay all or some of their Medicare Part D prescription drug costs. To find out if you qualify, call the Social Security Administration at (TTY ) between 7:00 a.m. and 7:00 p.m. EST, Monday through Friday; or visit the Social Security website at or visit your local Social Security office. If you are eligible for Medicare and Extra Help, you may qualify for a $0 monthly premium plan 10 from SilverScript. Your copays could be as low as $1.25 with Extra Help. 16

17 Glossary of Terms Coinsurance: An amount you may be required to pay as your share of the cost for prescription drugs after you pay any deductibles. Coinsurance is usually a percentage of the cost, e.g., 20%. Copayment (Copay): An amount you may be required to pay as your share of the cost for a prescription drug. A copay is usually a set dollar amount, e.g., $10. Cost Sharing: Any combination of deductible, copay and/or coinsurance (not including premiums) that you may need to pay for covered prescriptions. Deductible: An amount you are required to pay before a plan begins to share the cost of covered prescriptions. Formulary: List of prescription medications approved by Medicare to be covered in a Part D plan. Pharmacy Network: Pharmacies that contract with a Part D plan to provide prescription drugs to its members. Premium: A periodic payment (usually monthly) paid by a member to Medicare or a Medicareapproved insurer for coverage. 1 CMS Monthly Enrollment by Contract report, May SilverScript Choice has a $100 deductible on Tier 3-5 drugs in CO, GA, and TX; a $415 deductible on Tier 3-5 drugs in AZ and SC; and a $415 deductible on all Tiers in AK. 3 Alaska Choice plan has a standard pharmacy network only. 4 Plus plan and Allure plan not available in Alaska. 5 Percent savings based on SilverScript preferred vs. standard pharmacy copays. Savings may vary by state, drug tier and coverage stage. Call Customer Care for specific pricing of your medications. 6 $0 copay available on a 90-day supply in the initial coverage stage through CVS Caremark Mail Service Pharmacy for the following: Tier 1 for Choice and Allure, and Tiers 1 and 2 for Plus. Plus plan $0 copay also available in the coverage gap. 7 The typical number of business days after the mail order pharmacy receives an order to receive your shipment is up to 10 days. Enrollees have the option to sign up for automated mail order delivery. 8 16% savings based on three 30-day supplies of drugs in the initial coverage stage compared to one 90-day supply from CVS Caremark Mail Service Pharmacy for the following drugs: Tiers 2 and 3 for Choice (Tier 2 for Alaska Choice), Tier 3 for Plus, and Tier 2 for Allure. Cost savings may be lower for those who receive Extra Help. 9 If your birthday falls on the first day of any month, your 7-month Initial Enrollment Period (IEP) begins and ends one month sooner. For example, if your birthday is July 1, your 7-month IEP is the same as if you were born in June beginning in March and ending in September. 10 You must qualify for Medicare and Extra Help from Medicare to be eligible for $0 premiums on your prescription drug coverage. Note: $0 premium plans are not available in Alaska and Nevada. Benefits Reminders This information is not a complete description of benefits. Call (TTY:711) for more information. The formulary and pharmacy network may change at any time. You will receive notice when necessary. Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information. ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call (TTY: 711) 24 hours a day, 7 days a week. ATENCIÓN: Si usted habla español, tenemos servicios de asistencia lingüística disponibles para usted sin costo alguno. Llame al (TTY: 711), las 24 horas del día, los 7 días de la semana. 小贴士 : 如果您说中文, 欢迎使用免费语言协助服务. 请拨 (TTY: 711). 一周 7 天, 每天 24 小时随时受理. 17

18 Thank you for considering SilverScript. Enroll today and soon you ll find that we do more than provide Medicare Part D coverage. We offer value, convenience and peace of mind with every prescription. Ready to enroll or have questions? Call (TTY: 711) Or visit SilverScript.com 2018 SilverScript Insurance Company. All Rights Reserved.