2019 SilverScript Choice (PDP) S5601-040-000 in MS from SilverScript | HealthPocket

ZIP Code
County

Insurance Type	Medicare Advantage Prescription Drug Plan (Part D)
Insurance Provider	SilverScript
Plan ID	S5601-040-000
Plan Year	2019
CMS Rating
Plan Type	PDP
Annual Deductible	$0.00
Out-of-Pocket Maximum	N/A

What To Know About This Plan	This is a drug coverage only plan This plan is available for 2021. see plan

Why We Like This Plan	was the best selling plan in Harrison in 2021

Costs and Other Important Information

Plan Year	2019
Monthly Health Plan Premium	Not Applicable
Monthly Drug Plan Premium	$26.90
Health Plan Deductible	$185
Other health plan deductibles?	Yes
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	Not Applicable
Optional Supplemental Benefits	No

Benefits

SERVICE	COST
Inpatient hospital coverage	In 2019 the amounts for each benefit period are: $1,364 deductible for days 1 through 60 $341 copay per day for days 61 through 90
Outpatient hospital coverage	20% per visit
Doctor visits	Primary:20% per visit Specialist:20% per visit
Preventive care	$0 copay
Emergency care/Urgent care	Emergency:20% per visit (always covered) Urgent care:20% per visit (always covered)
Diagnostic procedures/lab services/imaging	Diagnostic tests and procedures:20% Lab services:20% Diagnostic radiology services (e.g., MRI):20% Outpatient x-rays:20%
Mental health services	Inpatient hospital - psychiatric:In 2019 the amounts for each benefit period are: $1,364 deductible for days 1 through 60 $341 copay per day for days 61 through 90 Outpatient group therapy visit with a psychiatrist:20% Outpatient individual therapy visit with a psychiatrist:20% Outpatient group therapy visit:20% Outpatient individual therapy visit:20%
Skilled Nursing Facility	In 2019 the amounts for each benefit period are: $0 copay for days 1 through 20 $170.50 copay per day for days 21 through 100
Rehabilitation services	Occupational therapy visit:20% Physical therapy and speech and language therapy visit:20%
Ground ambulance	20%
Transportation	No
Foot care (podiatry services)	Foot exams and treatment:20% Routine foot care:No
Medical equipment/supplies	Durable medical equipment (e.g., wheelchairs, oxygen):20% per item Prosthetics (e.g., braces, artificial limbs):20% per item Diabetes supplies:20% per item
Wellness programs (e.g., fitness, nursing hotline)	No
Medicare Part B drugs	Chemotherapy:20% Other Part B drugs:20%

Benefits Services

Hearing
Hearing exam	20%
Preventive Dental
Comprehensive Dental
Vision

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day Supply	Preferred Retail Pharmacies Drug Cost	Standard Retail Pharmacies Drug Cost	Preferred Mail-Order Drug Cost	Standard Mail-Order Drug Cost
Tier 1: Preferred Generic	$3 copay	$7 copay	$3 copay
Tier 2: Generic	$18 copay	$20 copay	$18 copay
Tier 3: Preferred Brand	$45 copay	$47 copay	$45 copay
Tier 4: Non-Preferred Drug	49% coinsurance	50% coinsurance	49% coinsurance
Tier 5: Specialty Tier	33% coinsurance	33% coinsurance	33% coinsurance

60 Day Supply	Preferred Retail Pharmacies Drug Cost	Standard Retail Pharmacies Drug Cost	Preferred Mail-Order Drug Cost	Standard Mail-Order Drug Cost
Tier 1: Preferred Generic	$6 copay	$14 copay	$6 copay
Tier 2: Generic	$36 copay	$40 copay	$36 copay
Tier 3: Preferred Brand	$90 copay	$94 copay	$90 copay
Tier 4: Non-Preferred Drug	49% coinsurance	50% coinsurance	49% coinsurance
Tier 5: Specialty Tier

90 Day Supply	Preferred Retail Pharmacies Drug Cost	Standard Retail Pharmacies Drug Cost	Preferred Mail-Order Drug Cost	Standard Mail-Order Drug Cost
Tier 1: Preferred Generic	$9 copay	$21 copay	$0 copay
Tier 2: Generic	$54 copay	$60 copay	$45 copay
Tier 3: Preferred Brand	$135 copay	$141 copay	$112.5 copay
Tier 4: Non-Preferred Drug	49% coinsurance	50% coinsurance	49% coinsurance
Tier 5: Specialty Tier

Pharmacies that accept SilverScript Choice (PDP) Prescription Drug Plan for Mississippi

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Cigna-HealthSpring Preferred (HMO)
COST:from $0	CMS Rating:

HumanaChoice H5216-158 (PPO)
COST:from $0	CMS Rating:

WellCare Value (HMO)
COST:from $0	CMS Rating:

Lasso Healthcare (MSA)
COST:from $0	CMS Rating:Not Rated

Allwell Medicare (HMO)
COST:from $0	CMS Rating:Not Rated

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.

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HealthPocket.com provides information on insurance products. If you choose to obtain a quote or apply for an insurance plan, you may be transferred to a partner website to complete your request. Always review the privacy and terms of use of the partner website.

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.