Frequently Asked Questions

I submitted incorrect information during my enrollment process. What should I do?

Call us at the number on the Contact Us page. Have your confirmation number and correct information on hand, and we'll take your information right over the phone.

If I sign up for one plan, can I switch to another plan if I decide that it would be better for me?

Similar to your health insurance, you are able to switch plans during a specific period each year. During the next enrollment period, if you decide to make a change, you can switch to another plan.

I have moved how do I update my address with you?

It is important that we have your current address. If your coverage changes we will notify you by mail. If you have moved, please call us at the number on the contact us page of this web site. We will update your information right away!

Do I have to submit receipts that show that I have met my deductible?

No, when you make your purchases at a pharmacy, and show them your plan membership card, they will process these payments so we have record of them. After you reach your deductible, you will be required to only pay based on the plan’s benefits, and the pharmacy will know to charge you only that amount. It’s good practice to keep your receipts in case there is ever a question about how much you have paid. This is especially true if you have some type of supplemental coverage.

What are drug tiers?

Tiers are the levels by which drugs are categorized to indicate the amount you will pay for that particular drug. The lowest cost tier contains the medications that will be most economical to you (generics are usually in Tier 1). Higher cost drugs are included in each increased tier level and typically require a higher contribution from you to obtain that particular drug.

The SilverScript Plus and SilverScript Complete plans have five tiers, while the SilverScript plan has four tiers. The additional tier will allow you more choices and lower prices when you choose Preferred Brand and generic drugs. The SilverScript Plus plan covers generics, in the coverage gap (often called donut hole) when they are purchased from our mail service or a network retail pharmacy.

What happens when I reach the coverage gap? How will I know and how do I pay?

Because all of your drug spending is recorded (see question and answer above), we will know when you reach the coverage gap, and your pharmacy bill will reflect the appropriate costs during that stage. Once you have hit the spending level to get coverage again, your pharmacy bills will also reflect the lower costs based on the plan’s benefits.

What is a formulary, and could the formulary change?

A formulary is a preferred list of drugs that has been developed to meet the needs of most patients based on most commonly prescribed drugs. There are drugs that are mandated by the government to be a part of each Medicare Prescription Drug Plan’s formulary.

A formulary is reviewed and updated on a regular basis by medical and pharmacy professionals. Prescriptions that are included in the plan’s formulary are called covered drugs. If a drug is not on the formulary, it is not covered and the plan’s benefits will not apply.

Formularies can change. If the formulary changes, affected enrollees will be notified before the change. You can visit this website to see the current formulary at any time as it will be updated regularly as needed. Should a drug that you are taking be removed from the formulary, you will be notified by us. Also, if you currently take a drug that is not on our formulary, you may appeal to ask us to cover that drug. Refer to your Evidence of Coverage for full details on the Appeal Process.

What are drug tiers?

Tiers are the levels by which drugs are categorized to indicate the amount you will pay for that particular drug. The lowest cost tier contains the medications that will be most economical to you (generics are usually in Tier 1). Higher cost drugs are included in each increased tier level and typically require a higher contribution from you to obtain that particular drug.

The SilverScript Plus and SilverScript Complete plans have five tiers, while the SilverScript plan has four tiers. The additional tier will allow you more choices and lower prices when you choose Preferred Brand and generic drugs. SilverScript Plus plan covers generics, including Value Generics at our preferred mail service pharmacy during the coverage gap.

What is a Preferred Brand Drug and a Non-Preferred Brand Drug?

Preferred brand drugs are those drugs selected by your plan that will provide greater savings than those drugs that are considered Non-Preferred Brand drugs.

Are the Pharmacies the same for all three plans?

Yes. All SilverScript plans provide access to over 62,000 pharmacies across the country. You can also choose to have your prescription filled and mailed directly to your home or office using our preferred mail service pharmacy. Additionally, there are specialty pharmacies such as Home Infusion pharmacies, Long-Term Care pharmacies, and Indian Health Service/Tribal/ Urban Indian Health Program pharmacies.

I was recently told I no longer qualify for my "extra help" subsidy what are my options?

SilverScript follows Medicare’s Best Available Evidence policy so if you have the necessary documentation, we can help you sort out your eligibility issues. Call Member Services at 1-866-552-6106, our highly-trained representatives are always ready to help.

What if I want to purchase a drug from a pharmacy that is not in the SilverScript pharmacy network?

You will receive benefit coverage for only drugs that are on the plan’s formulary and filled at a network pharmacy. Under certain circumstances you can obtain limited benefit coverage for a drug not filled at a network pharmacy. Click here for out-of-network information.

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