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SilverScript offers two Medicare Part D prescription drug plans - SilverScript Choice and SilverScript Plus - to provide affordable prescription drug coverage to eligible Medicare beneficiaries. The plans have $0 deductibles, low copayments, cover over 3,200 drugs, and include access to over 68,000 pharmacies nationwide as well as mail order drug delivery. A SilverScript agent can help enroll individuals and recommend the plan that best fits their health and budget needs.

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Y0080_12075_AGT_2016 SilverScript PDP 2016 Medicare Part D Prescription Drug Plans Note to Agent: • CMS has approved this 2016 client-facing presentation. • DO NOT deviate from or add information to this presentation.
2 My Qualifications I am here to help you enroll in the right Medicare coverage by: • Offering advice and answers about Medicare and Medicare Part D • Explaining terminology you may not understand • Providing information about SilverScript Prescription Drug Plans • Recommending coverage that is right for your health and your budget I am an independent insurance agent contracted with SilverScript Insurance Company. I have successfully completed the annual broker/agent Medicare Part D training course required by SilverScript Insurance Company. As a result, I am certified as a SilverScript Insurance Company agent. I may be compensated based on your enrollment in a SilverScript prescription drug plan.
3 4 . . . . Understanding Medicare 5 . . . . About SilverScript 6 . . . . Medicare Part D — Eligibility 7 . . . . Medicare Part D — Getting Prescription Drug Coverage 8 . . . . Medicare Part D — How the Four Stages of Part D Coverage Work 9 . . . . Medicare Part D — Enrollment Periods 10 . . . Important Date to Remember — Initial Enrollment Period 11 . . . Important Date to Remember — Annual Election Period 12 . . . Medicare Part D — Understanding Total Cost 13 . . . SilverScript Prescription Drug Plans — Two Plan Options for 2016 14 . . . SilverScript Choice 15 . . . SilverScript Choice — Prescription Drug Coverage 16 . . . SilverScript Plus 17 . . . SilverScript Plus — Prescription Drug Coverage 18 . . . Two Extensive Nationwide Pharmacy Networks 19 . . . What to Expect After You Enroll in a SilverScript Plan 20 . . . Five Questions to Ask When Choosing a Medicare Prescription Drug Plan 21 . . . Medicare Part D Terminology (Late Enrollment Penalty/Creditable Coverage) 22 . . . Medicare Part D Terminology (Part D-IRMAA) 23 . . . Medicare Part D Terminology (Extra Help) 24 . . . Important Reminders 25 . . . Citations & Clarifications 26 . . . Do You Have any Questions? Contents
4 TOGETHER, PART A & B ARE CALLED “ORIGINAL MEDICARE” Understanding Medicare Medicare Supplemental (Medigap) Plans • A Medicare Supplement (Medigap) plan can help pay for things not covered by Original Medicare, like copayments, coinsurance and deductibles. • Some Medigap policies offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. Hospital Insurance • Includes inpatient stays, skilled nursing, and home care PART A Medical Insurance • Doctor services, lab tests, outpatient and preventive care PART B Prescription Drug • Prescription Drug Coverage offered as a stand-alone plan (not joined with other insurance) or combined with a Medicare Advantage Prescription Drug Plan PART D Medicare Advantage (MA) Medicare Advantage-Prescription Drug (MA-PD) • Combines Parts A and B for plans that cover hospital and medical insurance • Sometimes available with or without prescription drug coverage PART C
5 About SilverScript The Medicare Part D program began in 2006 to help eligible Americans access and pay for their prescription drugs. As an approved plan sponsor, SilverScript Insurance Company is proud to celebrate 10 years of working within the Medicare program to help improve the health of America’s seniors and people with disabilities. More than 4.4 million1 people use SilverScript for their Medicare Part D Prescription Drug Coverage. Why? • Affordable plans • Extensive pharmacy network • Comprehensive coverage • Round-the-clock member support and assistance • Convenient CVS/caremark Mail Service Pharmacy2 More information about these features to come. FIRST, I’LL HELP YOU UNDERSTAND MORE ABOUT MEDICARE AND MEDICARE ELIGIBILITY.
6 You are eligible for Medicare Part D prescription drug coverage if you meet all three of the following requirements: • Must have Medicare Part A and/or B • You live in the plan’s service area • You are 65 or older, or under 65 and have received disability benefits from Social Security or the Railroad Retirement Board for at least 24 months3 People who qualify for enrollment in a Medicare-approved prescription drug plan are eligible to enroll in a Part D plan offered by the SilverScript Insurance Company. Medicare Part D Eligibility
7 Medicare Part D prescription drug coverage is available to you in one of three ways: 1. Enroll in a stand-alone PDP that offers prescription drug coverage only. SilverScript plans are stand- alone plans. 2. Enroll in a Medicare Advantage Plan that includes a prescription drug benefit, commonly known as Medicare Advantage Prescription Drug (MA-PD). 3. Enroll in Medicare Part A and Part B, a stand-alone PDP and optional Medigap insurance. Reminder: You may only be enrolled in one Medicare Part D prescription drug plan at any given time. Medicare Part D Getting Prescription Drug Coverage Rely on a qualified agent to help you understand your choices, our plans, how coverage works and how to use your benefits. Our goal is to help you decide which plan design will be right for you.
8 Medicare Part D How the Four Stages of Part D Coverage Work Deductible Stage (if applicable) The period of time when you pay the full cost of your prescriptions until your deductible is met and cost sharing begins. SilverScript plans do not require you to pay a deductible.4, 5 Initial Coverage Stage This stage begins after you reach your deductible. During this phase, cost-sharing begins, which means you pay a copayment or coinsurance for prescription drugs until you reach your plan’s initial coverage limit, which is $3,310. Coverage Gap Stage (Donut Hole) After you reach $3,310 in drug spending, this is the period of time when you have limited coverage for your medications, unless you are enrolled in a plan that provides coverage in the Gap. Catastrophic Coverage Stage You enter this stage after your out-of-pocket costs have reached $4,850. During this phase, you usually pay a low copayment or coinsurance for prescription drugs for the remainder of the plan year. 2 Initial Coverage 1 Yearly Deductible 4 Catastrophic Coverage 3 Coverage Gap The four phases of Medicare Part D prescription drug coverage The amount of coverage you have for prescription drugs may change throughout the year, depending on which stage you are in.
Initial Enrollment Period (IEP) Turning 65 Your 7-month IEP begins three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65.* Under 65 with a disability Your 7-month IEP begins 21 months after you get Social Security (SS) or Railroad Retirement Board (RRB) benefits and ends on the 27th month after you get SS or RRB benefits. Special Election Period (SEP) Medicare Part D allows a Special Enrollment Period when certain events occur, for example: • Moving out of your current plan’s service area • Losing creditable prescription drug coverage • Moving into a nursing home or long-term care facility • Your plan no longer offers coverage Annual Election Period(AEP) Enroll in a new prescription drug plan Switch from one prescription drug plan to another Annually: October 15—December 7 for coverage that begins January 1 of the following year. 9 Medicare Part D Enrollment Periods There are a lot of different SEP reasons. I can review them with you. *There is an exception: if your birthday falls on the first of any month, your 7-month 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 JAN FEB MAR APR MAY B-DAY JUN JUL AUG SEP OCT NOV DEC Important Date to Remember: Initial Enrollment Period Initial Enrollment Period (IEP) • The 7-month period when you are first eligible to enroll in a Medicare Part D plan. Your IEP begins the 3 months prior to your 65th birthday, the month of your 65th birthday, and the 3 months after your 65th birthday.† †  There is an exception: 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 May 1, your 7-month IEP is the same as if you were born in April — beginning in January and ending in July. Initial Enrollment Period
11 Important Date to Remember: Annual Election Period Annual Election Period (IEP) • October 15 through December 7 • Enroll in the plan of your choice for a January 1 effective date Ask your SilverScript representative if you qualify for a Special Election Period (SEP). Annual Election Period October 2015 July 2015 April 2015 January 2015 November 2015 August 2015 May 2015 February 2015 December 2015 September 2015 June 2015 March 2015
12 Medicare Part D Understanding Total Cost How much will your Medicare prescription drug plan cost? Be sure to include: • copays and coinsurance costs • annual deductible • monthly plan premiums Monthly premium x 12 Deductible (if applicable) Yearly drug copays or coinsurance + = + Total Annual Cost
13 SilverScript Prescription Drug Plans (PDP) Two PDP Plans to Meet Your Needs and Your Budget Don’t settle for less than SilverScript Today, more than 4.4 million1 people rely on SilverScript Part D coverage... and for all the right reasons. • Affordable: $0 deductible5 plans, low and no copays. • Trusted: Serving people with Medicare since Part D began. • Stable: America’s 2nd largest1 Part D provider. • Flexible: Choose from two plan options to cover your individual needs. • Comprehensive: More than 3,2006 drugs covered. • Strong: More than 68,0007 pharmacies, nationwide. • Convenient: CVS/caremark Mail Service Pharmacy2 enables prescription drug delivery to your home free of charge for standard delivery. • Supportive: 24/7 U.S.-based Customer Care. • Recognized: SilverScript is a member of the CVS/caremark family of companies dedicated to lowering health care costs and improving health outcomes for our valued members. This $0 deductible5 plan combines affordable premiums, low copays and the convenience of an extensive, nationwide pharmacy network to offer uncommon value for anyone who needs Medicare prescription drug coverage. No deductible means you could save hundreds of dollars in out-of- pocket costs, and your plan shares the cost of your prescriptions the very first day of coverage. SilverScript Choice (PDP) This enhanced plan is for people who take several prescriptions and are likely to reach the Coverage Gap. SilverScript Plus provides additional coverage for Tier 1 and Tier 2 drugs in the Gap to help lower your out-of-pocket costs. SilverScript Plus4 (PDP)
14 SilverScript Prescription Drug Plans SilverScript Choice SilverScript Choice ANNUAL DEDUCTIBLE $0 DEDUCTIBLE 5 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 (%) Standard Pharmacy Mail Service Pharmacy Preferred Standard DRUG TIERS 30-day 90-day 90-day Tier 1* Preferred Generic $3.00 or $5.00 $7.50 or $12.50 $7.50 or $12.50 $9.00 or $15.00 Tier 2* Generic $11.00 –$17.00 $27.50 –$42.50 $27.50 –$42.50 $33.00 –$51.00 Tier 3* Preferred Brand $37.00 –$47.00 $92.50 –$117.50 $92.50 –$117.50 $111.00 –$141.00 Tier 4* Non-Preferred Brand 42%–48% 42%–48% Tier 5* Specialty 33% N/A N/A COVERAGE GAP (DONUT HOLE) You leave the Initial Coverage stage and enter the Coverage Gap when you have reached $3,310 in total yearly drug costs (not including monthly premiums). Generic Drugs You pay 58% of the cost Brand Drugs You pay 45% of the cost CATASTROPHIC COVERAGE You enter the Catastrophic Coverage stage when you have spent $4,850 out of pocket (not including monthly premiums). Generic Drugs You pay the greater of 5% coinsurance or $2.95 copay All Other Drugs You pay the greater of 5% coinsurance or $7.40 copay *All Tiers may include generic and brand drugs. Alaska Choice Plan has a $360 deductible and Stage 2 copays/coinsurance of $1/$4/15%/35%/25% (Tiers 1-5). Call or visit the SilverScript website for more information.
15 2016 SilverScript Choice Prescription Drug Coverage Initial Coverage Stage: PATIENT PAYS: • Tier 1* Preferred Generic $3–$15 • Tier 2* Generic $11–$51 • Tier 3* Preferred Brand $37–$141 • Tier 4* Non-Preferred Brand 42%–48% • Tier 5* Specialty 33% or N/A Deductible Stage: PATIENT PAYS: $0 Deductible5 With SilverScript your Initial Coverage Stage begins on day 1 of plan coverage Catastrophic Coverage Stage: PATIENT PAYS: • The greater of 5% coinsurance or $2.95 copay Generic Drugs • The greater of 5% coinsurance or $7.40 copay All Other Drugs Coverage Gap Stage: PATIENT PAYS: • 58% Generics • 45% Brands Total Drug Spend = $3,310 ENTER Coverage Gap Out-of-Pocket Expenses = $4,850 EXIT Coverage Gap *All Tiers may include generic and brand drugs. Alaska Choice Plan has a $360 deductible and Stage 2 copays/coinsurance of $1/$4/15%/35%/25% (Tiers 1-5).
16 SilverScript Prescription Drug Plans SilverScript Plus SilverScript Plus ANNUAL DEDUCTIBLE $0 DEDUCTIBLE 5 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 Mail Service Pharmacy Preferred Standard DRUG TIERS 30-day 90-day 30-day 90-day 90-day Tier 1** Preferred Generic $0 $0 $7.00 $21.00 $0 $21.00 Tier 2** Generic $3.00 $7.50 $10.00 $30.00 $0 $30.00 Tier 3** Preferred Brand $22.00 $55.00 $29.00 $87.00 $55.00 $87.00 Tier 4** Non-Preferred Brand 35% 45% 35% 45% Tier 5** Specialty 33% N/A 33% N/A N/A COVERAGE GAP (DONUT HOLE) You leave the Initial Coverage stage and enter the Coverage Gap when you have reached $3,310 in total yearly drug costs (not including monthly premiums). 30-day 90-day 30-day 90-day 90-day Tier 1 (no more than) $0 $0 $7.00 $21.00 $0 $21.00 Tier 2 (no more than) $3.00 $7.50 $10.00 $30.00 $0 $30.00 Tiers 3, 4 and 5 Generic Drugs You pay 58% of the cost Brand Drugs You pay 45% of the cost CATASTROPHIC COVERAGE You enter the Catastrophic Coverage stage when you have spent $4,850 out of pocket (not including monthly premiums). Generic Drugs You pay the greater of 5% coinsurance or $2.95 copay All Other Drugs You pay the greater of 5% coinsurance or $7.40 copay **All Tiers may include generic and brand drugs.
17 Initial Coverage Stage: PATIENT PAYS: • Tier 1** Preferred Generic $0–$21 • Tier 2** Generic $0–$30 • Tier 3** Preferred Brand $22–$87 • Tier 4** Non-Preferred Brand 35%–45% • Tier 5** Specialty 33% or N/A Deductible Stage: PATIENT PAYS: $0 Deductible5 With SilverScript your Initial Coverage Stage begins on day 1 of plan coverage Catastrophic Coverage Stage: PATIENT PAYS: • The greater of 5% coinsurance or $2.95 copay Generic Drugs • The greater of 5% coinsurance or $7.40 copay All Other Drugs Coverage Gap Stage: PATIENT PAYS: • $0–$21 Tier 1 • $0–$30 Tier 2 • 58% Generics/ 45% Brands Tiers 3, 4 and 5 Total Drug Spend = $3,310 ENTER Coverage Gap Out-of-Pocket Expenses = $4,850 EXIT Coverage Gap 2016 SilverScript Plus 4 Prescription Drug Coverage **All Tiers may include generic and brand drugs.
18 At home or traveling the U.S., it’s reassuring to know that we’re never far from where you are. SilverScript has your convenience covered, too. SilverScript Choice network—one low copay, coast to coast. Fill your prescriptions at more than 66,0007 Choice pharmacies and enjoy the same low copays and coinsurance. Two Extensive Nationwide Pharmacy Networks Plus, thousands of community-based, independent pharmacies. SilverScript Plus network—more pharmacies, more savings! Get all the advantages of the Choice network, plus even more pharmacies—more than 68,0007 nationwide. You’ll also get “preferred” savings, thanks to the lowest copays and coinsurance at over 40,0007 preferred pharmacies. AN AAP SUBSIDIARY Employee Owned ®
19 What to Expect After You Enroll in a SilverScript Plan WHAT TO EXPECT IN THE MAIL: DESCRIPTION: ENROLLMENT VERIFICATION LETTER (OEV) A letter verifying your intent to enroll in a SilverScript PDP. ACKNOWLEDGMENT OF APPLICATION LETTER A letter acknowledging that we’ve received your enrollment application and have sent it to Medicare for processing. ENROLLMENT CONFIRMATION AND ID CARD: 2016 Member ID Card SilverScript ID card valid beginning January 1, 2016. You will need to present your ID Card whenever you visit a pharmacy. Medicare Part D Enrollment Confirmation A letter confirming that Medicare has approved your enrollment in SilverScript. WELCOME KIT: New Member Reference Guide New Member Reference Guide, a quick reference tool to help you get started with your SilverScript plan. CVS/caremark Mail Service Pharmacy Order Form A form to get you started using our mail service pharmacy. There is no cost for standard deliveries! Pharmacy Directory A list of nearby pharmacies including a brief description, contact information and pharmacy services. Formulary Update The most current list of additions, deletions and changes to our list of covered drugs. Evidence of Coverage Booklet A guide to using your benefits explaining how your coverage works, the services we offer and your rights and responsibilities.
20 Five Questions to Ask When Choosing a Medicare Prescription Drug Plan Do I have the right kind of coverage? Are the drugs I take covered by the plan? Is the pharmacy I use in the plan’s network? Does the plan offer me the convenience of mail service pharmacy? Is the plan helpful when I need assistance? 1 2 3 4 5
21 Late Enrollment Penalty You may be subject to a Late Enrollment Penalty (LEP) if, at any time after your Initial Enrollment Period is over, there is a period of 63 or more days in a row when you did not have Medicare Part D or other creditable prescription drug coverage. The amount of your LEP depends on how long you went without creditable prescription drug coverage. Creditable Prescription Drug Coverage Creditable prescription drug coverage is coverage (from an employer, union or independent) that is at least as good as Medicare’s standard prescription drug coverage. If you have this kind of coverage when you become eligible for Medicare, you can generally keep it and not be subject to a Late Enrollment Penalty if you decide to enroll at a later time. Note: If you get Extra Help, you are not subject to Medicare Part D’s Late Enrollment Penalty. See slide 23 for more information about Extra Help. Medicare Part D Terminology Phrases You Need to Understand 1 2
22 Medicare Part D Terminology (continued) Phrases You Need to Understand Part D-Income Related Monthly Adjustment Amount (Part D-IRMAA) The Part D-Income Related Monthly Adjustment Amount is a premium amount separate from the Part D plan’s monthly premium for individuals who have incomes over a certain amount. The Social Security Administration assesses the amount annually based on the enrollee’s available tax information. If your income is above a certain limit, you’ll pay an extra amount in addition to your plan premium. For example, if your 2014 reported yearly income as a single taxpayer is greater than $85,000, (greater than $170,000 filing jointly), you will be responsible for paying an additional $12.30. This is in addition to your monthly premium. Usually, the extra amount will be deducted from your Social Security check or billed by the Railroad Retirement Board (RRB), if you get benefits from the RRB. If you’re billed the amount by Medicare or the RRB, you must pay the extra amount to Medicare or the RRB and not your Part D plan. Important points to keep in mind: • If you owe an IRMAA, Social Security will send you a letter notifying you that the extra amount you owe will be added to your Medicare Part D premium. • The Part D-IRMAA is billed directly by the Centers for Medicare and Medicaid Services, which means any IRMAA payment should NOT be sent to your prescription drug plan. • If you do not pay your IRMAA, you risk disenrollment from your Medicare Part D plan. • More information about the Part D-IRMAA can be found at www.medicare.gov 3
23 Extra Help Many people qualify for Extra Help from Medicare and don’t even know it. If you believe you qualify for Extra Help, complete the Application for Extra Help with Medicare Prescription Drug Plan Costs and submit it to the Social Security Administration. To qualify, you must meet three requirements: 1. Your Residence You must reside in one of the 50 States or the District of Columbia. 2. Your Resources Must be limited to $13,640 for an individual or $27,250 for a married couple living together. (Resources include bank accounts, stocks and bonds, but do not include your home, car or life insurance policies). Limits are subject to change. 3. Your Income Must be limited to $17,655 for an individual, $23,895 for a married couple living together (limits are subject to change). Even if your income is higher, you may be eligible for some help. Medicare Part D Terminology (continued) Phrases You Need to Understand 4 By Phone Call Social Security toll free at 1-800-772-1213 (TTY 711), between 8:00 a.m. and 7:00 p.m. EST, Monday through Friday. Online Visit the Social Security website at www.socialsecurity.gov In Person Apply at your local Social Security office
24 • Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information. • Members may enroll in the plan only during specific times of the year. Contact the plan for more information. • Eligible beneficiaries must use the network pharmacies to access their prescription drug benefit, except under non-routine circumstances (quantity limitations and restrictions apply.) • This information is not a complete description of benefits. Contact the plan for more information. • Limitations, copayments and restrictions may apply. • Benefits, premium and/or copayments/coinsurance may change on January 1 of each year. • You must continue to pay your Medicare Part B premium. • The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. • This information is available for free in other languages. Please call our Customer Care number at 1-855-771-9286 (TTY: 711), 24 hours a day, 7 days a week. Esta información está disponible gratuitamente en otros idiomas. Llame a nuestro Cuidado al Cliente, al 1-855-771-9286 (teléfono de texto (TTY): 711), las 24 horas del día, los 7 días de la semana. • SilverScript is a Prescription Drug Plan with a Medicare contract offered by SilverScript Insurance Company. Enrollment in SilverScript depends on contract renewal. Important Reminders
25 1 CMS, Monthly Enrollment by Plan report, July, 2015. https://www.cms.gov/Research-Statistics-Data-and- Systems/Statistics-Trends-and-Reports/MCRAdvPartDEnrolData/Monthly-Enrollment-by-Plan.html 2 The typical number of 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. 3 There is no 24-month waiting period if you have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, or End Stage Renal Disease (ESRD) with resulting dialysis treatment or a kidney transplant. 4 SilverScript Plus (PDP) not available in Alaska. 5 Choice plan in Alaska has a premium of $39.90 and deductible of $360. 6 SilverScript Insurance Company Formulary, July 2015. 7 Internal SilverScript Insurance Company reports dated July 2015. Citations Clarifications
26 Do You Have Any Questions? SilverScript is a Prescription Drug Plan with a Medicare contract offered by SilverScript Insurance Company. Enrollment in SilverScript depends on contract renewal. ©2016 SilverScript Insurance Company. All Rights Reserved. Thank you for considering SilverScript. For additional information, please consult your certified SilverScript Agent or call us at: 1-855-771-9286 (TTY: 711) 24 hours a day, 7 days a week. Visit us online at silverscript.com

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Sales presentation

  • 1.
    Y0080_12075_AGT_2016 SilverScript PDP 2016 MedicarePart D Prescription Drug Plans Note to Agent: • CMS has approved this 2016 client-facing presentation. • DO NOT deviate from or add information to this presentation.
  • 2.
    2 My Qualifications I amhere to help you enroll in the right Medicare coverage by: • Offering advice and answers about Medicare and Medicare Part D • Explaining terminology you may not understand • Providing information about SilverScript Prescription Drug Plans • Recommending coverage that is right for your health and your budget I am an independent insurance agent contracted with SilverScript Insurance Company. I have successfully completed the annual broker/agent Medicare Part D training course required by SilverScript Insurance Company. As a result, I am certified as a SilverScript Insurance Company agent. I may be compensated based on your enrollment in a SilverScript prescription drug plan.
  • 3.
    3 4 . . . . Understanding Medicare 5 . . . . About SilverScript 6 . . . . Medicare Part D — Eligibility 7 . . . . Medicare Part D — Getting Prescription Drug Coverage 8 . . . . Medicare Part D — How the Four Stages of Part D Coverage Work 9 . . . . Medicare Part D — Enrollment Periods 10 . . . Important Date to Remember — Initial Enrollment Period 11 . . . Important Date to Remember — Annual Election Period 12 . . . Medicare Part D — Understanding Total Cost 13 . . . SilverScript Prescription Drug Plans — Two Plan Options for 2016 14 . . . SilverScript Choice 15 . . . SilverScript Choice — Prescription Drug Coverage 16 . . . SilverScript Plus 17 . . . SilverScript Plus — Prescription Drug Coverage 18 . . . Two Extensive Nationwide Pharmacy Networks 19 . . . What to Expect After You Enroll in a SilverScript Plan 20 . . . Five Questions to Ask When Choosing a Medicare Prescription Drug Plan 21 . . . Medicare Part D Terminology (Late Enrollment Penalty/Creditable Coverage) 22 . . . Medicare Part D Terminology (Part D-IRMAA) 23 . . . Medicare Part D Terminology (Extra Help) 24 . . . Important Reminders 25 . . . Citations & Clarifications 26 . . . Do You Have any Questions? Contents
  • 4.
    4 TOGETHER, PART A& B ARE CALLED “ORIGINAL MEDICARE” Understanding Medicare Medicare Supplemental (Medigap) Plans • A Medicare Supplement (Medigap) plan can help pay for things not covered by Original Medicare, like copayments, coinsurance and deductibles. • Some Medigap policies offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. Hospital Insurance • Includes inpatient stays, skilled nursing, and home care PART A Medical Insurance • Doctor services, lab tests, outpatient and preventive care PART B Prescription Drug • Prescription Drug Coverage offered as a stand-alone plan (not joined with other insurance) or combined with a Medicare Advantage Prescription Drug Plan PART D Medicare Advantage (MA) Medicare Advantage-Prescription Drug (MA-PD) • Combines Parts A and B for plans that cover hospital and medical insurance • Sometimes available with or without prescription drug coverage PART C
  • 5.
    5 About SilverScript The MedicarePart D program began in 2006 to help eligible Americans access and pay for their prescription drugs. As an approved plan sponsor, SilverScript Insurance Company is proud to celebrate 10 years of working within the Medicare program to help improve the health of America’s seniors and people with disabilities. More than 4.4 million1 people use SilverScript for their Medicare Part D Prescription Drug Coverage. Why? • Affordable plans • Extensive pharmacy network • Comprehensive coverage • Round-the-clock member support and assistance • Convenient CVS/caremark Mail Service Pharmacy2 More information about these features to come. FIRST, I’LL HELP YOU UNDERSTAND MORE ABOUT MEDICARE AND MEDICARE ELIGIBILITY.
  • 6.
    6 You are eligiblefor Medicare Part D prescription drug coverage if you meet all three of the following requirements: • Must have Medicare Part A and/or B • You live in the plan’s service area • You are 65 or older, or under 65 and have received disability benefits from Social Security or the Railroad Retirement Board for at least 24 months3 People who qualify for enrollment in a Medicare-approved prescription drug plan are eligible to enroll in a Part D plan offered by the SilverScript Insurance Company. Medicare Part D Eligibility
  • 7.
    7 Medicare Part Dprescription drug coverage is available to you in one of three ways: 1. Enroll in a stand-alone PDP that offers prescription drug coverage only. SilverScript plans are stand- alone plans. 2. Enroll in a Medicare Advantage Plan that includes a prescription drug benefit, commonly known as Medicare Advantage Prescription Drug (MA-PD). 3. Enroll in Medicare Part A and Part B, a stand-alone PDP and optional Medigap insurance. Reminder: You may only be enrolled in one Medicare Part D prescription drug plan at any given time. Medicare Part D Getting Prescription Drug Coverage Rely on a qualified agent to help you understand your choices, our plans, how coverage works and how to use your benefits. Our goal is to help you decide which plan design will be right for you.
  • 8.
    8 Medicare Part D Howthe Four Stages of Part D Coverage Work Deductible Stage (if applicable) The period of time when you pay the full cost of your prescriptions until your deductible is met and cost sharing begins. SilverScript plans do not require you to pay a deductible.4, 5 Initial Coverage Stage This stage begins after you reach your deductible. During this phase, cost-sharing begins, which means you pay a copayment or coinsurance for prescription drugs until you reach your plan’s initial coverage limit, which is $3,310. Coverage Gap Stage (Donut Hole) After you reach $3,310 in drug spending, this is the period of time when you have limited coverage for your medications, unless you are enrolled in a plan that provides coverage in the Gap. Catastrophic Coverage Stage You enter this stage after your out-of-pocket costs have reached $4,850. During this phase, you usually pay a low copayment or coinsurance for prescription drugs for the remainder of the plan year. 2 Initial Coverage 1 Yearly Deductible 4 Catastrophic Coverage 3 Coverage Gap The four phases of Medicare Part D prescription drug coverage The amount of coverage you have for prescription drugs may change throughout the year, depending on which stage you are in.
  • 9.
    Initial Enrollment Period (IEP) Turning65 Your 7-month IEP begins three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65.* Under 65 with a disability Your 7-month IEP begins 21 months after you get Social Security (SS) or Railroad Retirement Board (RRB) benefits and ends on the 27th month after you get SS or RRB benefits. Special Election Period (SEP) Medicare Part D allows a Special Enrollment Period when certain events occur, for example: • Moving out of your current plan’s service area • Losing creditable prescription drug coverage • Moving into a nursing home or long-term care facility • Your plan no longer offers coverage Annual Election Period(AEP) Enroll in a new prescription drug plan Switch from one prescription drug plan to another Annually: October 15—December 7 for coverage that begins January 1 of the following year. 9 Medicare Part D Enrollment Periods There are a lot of different SEP reasons. I can review them with you. *There is an exception: if your birthday falls on the first of any month, your 7-month 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.
    10 JAN FEB MARAPR MAY B-DAY JUN JUL AUG SEP OCT NOV DEC Important Date to Remember: Initial Enrollment Period Initial Enrollment Period (IEP) • The 7-month period when you are first eligible to enroll in a Medicare Part D plan. Your IEP begins the 3 months prior to your 65th birthday, the month of your 65th birthday, and the 3 months after your 65th birthday.† †  There is an exception: 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 May 1, your 7-month IEP is the same as if you were born in April — beginning in January and ending in July. Initial Enrollment Period
  • 11.
    11 Important Date toRemember: Annual Election Period Annual Election Period (IEP) • October 15 through December 7 • Enroll in the plan of your choice for a January 1 effective date Ask your SilverScript representative if you qualify for a Special Election Period (SEP). Annual Election Period October 2015 July 2015 April 2015 January 2015 November 2015 August 2015 May 2015 February 2015 December 2015 September 2015 June 2015 March 2015
  • 12.
    12 Medicare Part D UnderstandingTotal Cost How much will your Medicare prescription drug plan cost? Be sure to include: • copays and coinsurance costs • annual deductible • monthly plan premiums Monthly premium x 12 Deductible (if applicable) Yearly drug copays or coinsurance + = + Total Annual Cost
  • 13.
    13 SilverScript Prescription DrugPlans (PDP) Two PDP Plans to Meet Your Needs and Your Budget Don’t settle for less than SilverScript Today, more than 4.4 million1 people rely on SilverScript Part D coverage... and for all the right reasons. • Affordable: $0 deductible5 plans, low and no copays. • Trusted: Serving people with Medicare since Part D began. • Stable: America’s 2nd largest1 Part D provider. • Flexible: Choose from two plan options to cover your individual needs. • Comprehensive: More than 3,2006 drugs covered. • Strong: More than 68,0007 pharmacies, nationwide. • Convenient: CVS/caremark Mail Service Pharmacy2 enables prescription drug delivery to your home free of charge for standard delivery. • Supportive: 24/7 U.S.-based Customer Care. • Recognized: SilverScript is a member of the CVS/caremark family of companies dedicated to lowering health care costs and improving health outcomes for our valued members. This $0 deductible5 plan combines affordable premiums, low copays and the convenience of an extensive, nationwide pharmacy network to offer uncommon value for anyone who needs Medicare prescription drug coverage. No deductible means you could save hundreds of dollars in out-of- pocket costs, and your plan shares the cost of your prescriptions the very first day of coverage. SilverScript Choice (PDP) This enhanced plan is for people who take several prescriptions and are likely to reach the Coverage Gap. SilverScript Plus provides additional coverage for Tier 1 and Tier 2 drugs in the Gap to help lower your out-of-pocket costs. SilverScript Plus4 (PDP)
  • 14.
    14 SilverScript Prescription DrugPlans SilverScript Choice SilverScript Choice ANNUAL DEDUCTIBLE $0 DEDUCTIBLE 5 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 (%) Standard Pharmacy Mail Service Pharmacy Preferred Standard DRUG TIERS 30-day 90-day 90-day Tier 1* Preferred Generic $3.00 or $5.00 $7.50 or $12.50 $7.50 or $12.50 $9.00 or $15.00 Tier 2* Generic $11.00 –$17.00 $27.50 –$42.50 $27.50 –$42.50 $33.00 –$51.00 Tier 3* Preferred Brand $37.00 –$47.00 $92.50 –$117.50 $92.50 –$117.50 $111.00 –$141.00 Tier 4* Non-Preferred Brand 42%–48% 42%–48% Tier 5* Specialty 33% N/A N/A COVERAGE GAP (DONUT HOLE) You leave the Initial Coverage stage and enter the Coverage Gap when you have reached $3,310 in total yearly drug costs (not including monthly premiums). Generic Drugs You pay 58% of the cost Brand Drugs You pay 45% of the cost CATASTROPHIC COVERAGE You enter the Catastrophic Coverage stage when you have spent $4,850 out of pocket (not including monthly premiums). Generic Drugs You pay the greater of 5% coinsurance or $2.95 copay All Other Drugs You pay the greater of 5% coinsurance or $7.40 copay *All Tiers may include generic and brand drugs. Alaska Choice Plan has a $360 deductible and Stage 2 copays/coinsurance of $1/$4/15%/35%/25% (Tiers 1-5). Call or visit the SilverScript website for more information.
  • 15.
    15 2016 SilverScript Choice PrescriptionDrug Coverage Initial Coverage Stage: PATIENT PAYS: • Tier 1* Preferred Generic $3–$15 • Tier 2* Generic $11–$51 • Tier 3* Preferred Brand $37–$141 • Tier 4* Non-Preferred Brand 42%–48% • Tier 5* Specialty 33% or N/A Deductible Stage: PATIENT PAYS: $0 Deductible5 With SilverScript your Initial Coverage Stage begins on day 1 of plan coverage Catastrophic Coverage Stage: PATIENT PAYS: • The greater of 5% coinsurance or $2.95 copay Generic Drugs • The greater of 5% coinsurance or $7.40 copay All Other Drugs Coverage Gap Stage: PATIENT PAYS: • 58% Generics • 45% Brands Total Drug Spend = $3,310 ENTER Coverage Gap Out-of-Pocket Expenses = $4,850 EXIT Coverage Gap *All Tiers may include generic and brand drugs. Alaska Choice Plan has a $360 deductible and Stage 2 copays/coinsurance of $1/$4/15%/35%/25% (Tiers 1-5).
  • 16.
    16 SilverScript Prescription DrugPlans SilverScript Plus SilverScript Plus ANNUAL DEDUCTIBLE $0 DEDUCTIBLE 5 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 Mail Service Pharmacy Preferred Standard DRUG TIERS 30-day 90-day 30-day 90-day 90-day Tier 1** Preferred Generic $0 $0 $7.00 $21.00 $0 $21.00 Tier 2** Generic $3.00 $7.50 $10.00 $30.00 $0 $30.00 Tier 3** Preferred Brand $22.00 $55.00 $29.00 $87.00 $55.00 $87.00 Tier 4** Non-Preferred Brand 35% 45% 35% 45% Tier 5** Specialty 33% N/A 33% N/A N/A COVERAGE GAP (DONUT HOLE) You leave the Initial Coverage stage and enter the Coverage Gap when you have reached $3,310 in total yearly drug costs (not including monthly premiums). 30-day 90-day 30-day 90-day 90-day Tier 1 (no more than) $0 $0 $7.00 $21.00 $0 $21.00 Tier 2 (no more than) $3.00 $7.50 $10.00 $30.00 $0 $30.00 Tiers 3, 4 and 5 Generic Drugs You pay 58% of the cost Brand Drugs You pay 45% of the cost CATASTROPHIC COVERAGE You enter the Catastrophic Coverage stage when you have spent $4,850 out of pocket (not including monthly premiums). Generic Drugs You pay the greater of 5% coinsurance or $2.95 copay All Other Drugs You pay the greater of 5% coinsurance or $7.40 copay **All Tiers may include generic and brand drugs.
  • 17.
    17 Initial Coverage Stage: PATIENT PAYS: • Tier 1** Preferred Generic $0–$21 • Tier 2** Generic $0–$30 • Tier 3** Preferred Brand $22–$87 • Tier 4** Non-Preferred Brand 35%–45% • Tier 5** Specialty 33% or N/A Deductible Stage: PATIENT PAYS: $0 Deductible5 With SilverScript your Initial Coverage Stage begins on day 1 of plan coverage Catastrophic Coverage Stage: PATIENT PAYS: • The greater of 5% coinsurance or $2.95 copay Generic Drugs • The greater of 5% coinsurance or $7.40 copay All Other Drugs Coverage Gap Stage: PATIENT PAYS: • $0–$21 Tier 1 • $0–$30 Tier 2 • 58% Generics/ 45% Brands Tiers 3, 4 and 5 Total Drug Spend = $3,310 ENTER Coverage Gap Out-of-Pocket Expenses = $4,850 EXIT Coverage Gap 2016 SilverScript Plus 4 Prescription Drug Coverage **All Tiers may include generic and brand drugs.
  • 18.
    18 At home ortraveling the U.S., it’s reassuring to know that we’re never far from where you are. SilverScript has your convenience covered, too. SilverScript Choice network—one low copay, coast to coast. Fill your prescriptions at more than 66,0007 Choice pharmacies and enjoy the same low copays and coinsurance. Two Extensive Nationwide Pharmacy Networks Plus, thousands of community-based, independent pharmacies. SilverScript Plus network—more pharmacies, more savings! Get all the advantages of the Choice network, plus even more pharmacies—more than 68,0007 nationwide. You’ll also get “preferred” savings, thanks to the lowest copays and coinsurance at over 40,0007 preferred pharmacies. AN AAP SUBSIDIARY Employee Owned ®
  • 19.
    19 What to ExpectAfter You Enroll in a SilverScript Plan WHAT TO EXPECT IN THE MAIL: DESCRIPTION: ENROLLMENT VERIFICATION LETTER (OEV) A letter verifying your intent to enroll in a SilverScript PDP. ACKNOWLEDGMENT OF APPLICATION LETTER A letter acknowledging that we’ve received your enrollment application and have sent it to Medicare for processing. ENROLLMENT CONFIRMATION AND ID CARD: 2016 Member ID Card SilverScript ID card valid beginning January 1, 2016. You will need to present your ID Card whenever you visit a pharmacy. Medicare Part D Enrollment Confirmation A letter confirming that Medicare has approved your enrollment in SilverScript. WELCOME KIT: New Member Reference Guide New Member Reference Guide, a quick reference tool to help you get started with your SilverScript plan. CVS/caremark Mail Service Pharmacy Order Form A form to get you started using our mail service pharmacy. There is no cost for standard deliveries! Pharmacy Directory A list of nearby pharmacies including a brief description, contact information and pharmacy services. Formulary Update The most current list of additions, deletions and changes to our list of covered drugs. Evidence of Coverage Booklet A guide to using your benefits explaining how your coverage works, the services we offer and your rights and responsibilities.
  • 20.
    20 Five Questions toAsk When Choosing a Medicare Prescription Drug Plan Do I have the right kind of coverage? Are the drugs I take covered by the plan? Is the pharmacy I use in the plan’s network? Does the plan offer me the convenience of mail service pharmacy? Is the plan helpful when I need assistance? 1 2 3 4 5
  • 21.
    21 Late Enrollment Penalty Youmay be subject to a Late Enrollment Penalty (LEP) if, at any time after your Initial Enrollment Period is over, there is a period of 63 or more days in a row when you did not have Medicare Part D or other creditable prescription drug coverage. The amount of your LEP depends on how long you went without creditable prescription drug coverage. Creditable Prescription Drug Coverage Creditable prescription drug coverage is coverage (from an employer, union or independent) that is at least as good as Medicare’s standard prescription drug coverage. If you have this kind of coverage when you become eligible for Medicare, you can generally keep it and not be subject to a Late Enrollment Penalty if you decide to enroll at a later time. Note: If you get Extra Help, you are not subject to Medicare Part D’s Late Enrollment Penalty. See slide 23 for more information about Extra Help. Medicare Part D Terminology Phrases You Need to Understand 1 2
  • 22.
    22 Medicare Part DTerminology (continued) Phrases You Need to Understand Part D-Income Related Monthly Adjustment Amount (Part D-IRMAA) The Part D-Income Related Monthly Adjustment Amount is a premium amount separate from the Part D plan’s monthly premium for individuals who have incomes over a certain amount. The Social Security Administration assesses the amount annually based on the enrollee’s available tax information. If your income is above a certain limit, you’ll pay an extra amount in addition to your plan premium. For example, if your 2014 reported yearly income as a single taxpayer is greater than $85,000, (greater than $170,000 filing jointly), you will be responsible for paying an additional $12.30. This is in addition to your monthly premium. Usually, the extra amount will be deducted from your Social Security check or billed by the Railroad Retirement Board (RRB), if you get benefits from the RRB. If you’re billed the amount by Medicare or the RRB, you must pay the extra amount to Medicare or the RRB and not your Part D plan. Important points to keep in mind: • If you owe an IRMAA, Social Security will send you a letter notifying you that the extra amount you owe will be added to your Medicare Part D premium. • The Part D-IRMAA is billed directly by the Centers for Medicare and Medicaid Services, which means any IRMAA payment should NOT be sent to your prescription drug plan. • If you do not pay your IRMAA, you risk disenrollment from your Medicare Part D plan. • More information about the Part D-IRMAA can be found at www.medicare.gov 3
  • 23.
    23 Extra Help Many peoplequalify for Extra Help from Medicare and don’t even know it. If you believe you qualify for Extra Help, complete the Application for Extra Help with Medicare Prescription Drug Plan Costs and submit it to the Social Security Administration. To qualify, you must meet three requirements: 1. Your Residence You must reside in one of the 50 States or the District of Columbia. 2. Your Resources Must be limited to $13,640 for an individual or $27,250 for a married couple living together. (Resources include bank accounts, stocks and bonds, but do not include your home, car or life insurance policies). Limits are subject to change. 3. Your Income Must be limited to $17,655 for an individual, $23,895 for a married couple living together (limits are subject to change). Even if your income is higher, you may be eligible for some help. Medicare Part D Terminology (continued) Phrases You Need to Understand 4 By Phone Call Social Security toll free at 1-800-772-1213 (TTY 711), between 8:00 a.m. and 7:00 p.m. EST, Monday through Friday. Online Visit the Social Security website at www.socialsecurity.gov In Person Apply at your local Social Security office
  • 24.
    24 • Your privacy isimportant to us. Our employees are trained regarding the appropriate way to handle your private health information. • Members may enroll in the plan only during specific times of the year. Contact the plan for more information. • Eligible beneficiaries must use the network pharmacies to access their prescription drug benefit, except under non-routine circumstances (quantity limitations and restrictions apply.) • This information is not a complete description of benefits. Contact the plan for more information. • Limitations, copayments and restrictions may apply. • Benefits, premium and/or copayments/coinsurance may change on January 1 of each year. • You must continue to pay your Medicare Part B premium. • The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. • This information is available for free in other languages. Please call our Customer Care number at 1-855-771-9286 (TTY: 711), 24 hours a day, 7 days a week. Esta información está disponible gratuitamente en otros idiomas. Llame a nuestro Cuidado al Cliente, al 1-855-771-9286 (teléfono de texto (TTY): 711), las 24 horas del día, los 7 días de la semana. • SilverScript is a Prescription Drug Plan with a Medicare contract offered by SilverScript Insurance Company. Enrollment in SilverScript depends on contract renewal. Important Reminders
  • 25.
    25 1 CMS, MonthlyEnrollment by Plan report, July, 2015. https://www.cms.gov/Research-Statistics-Data-and- Systems/Statistics-Trends-and-Reports/MCRAdvPartDEnrolData/Monthly-Enrollment-by-Plan.html 2 The typical number of 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. 3 There is no 24-month waiting period if you have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, or End Stage Renal Disease (ESRD) with resulting dialysis treatment or a kidney transplant. 4 SilverScript Plus (PDP) not available in Alaska. 5 Choice plan in Alaska has a premium of $39.90 and deductible of $360. 6 SilverScript Insurance Company Formulary, July 2015. 7 Internal SilverScript Insurance Company reports dated July 2015. Citations Clarifications
  • 26.
    26 Do You HaveAny Questions? SilverScript is a Prescription Drug Plan with a Medicare contract offered by SilverScript Insurance Company. Enrollment in SilverScript depends on contract renewal. ©2016 SilverScript Insurance Company. All Rights Reserved. Thank you for considering SilverScript. For additional information, please consult your certified SilverScript Agent or call us at: 1-855-771-9286 (TTY: 711) 24 hours a day, 7 days a week. Visit us online at silverscript.com