The prescription drug coverage for Medicare-eligible retirees and their Medicare-eligible spouse and/or dependents in the GIC's UniCare State Indemnity Plan/Medicare Extension (OME), and effective July 1, 2017, all GIC Medicare plans are provided by SilverScript. The plan combines a standard Medicare Part D prescription drug plan with additional coverage provided by the GIC.
Updated on June, 2018.
SilverScript Employer PDP sponsored by The Group Insurance Commission
SilverScript Employer PDP sponsored by The Group Insurance Commission (SilverScript) is a Medicare Part D prescription drug plan which is sponsored by the GIC for Medicare-eligible retirees and/or their Medicare-eligible spouse and dependents in all GIC Medicare plans.
SilverScript is offered by SilverScript® Insurance Company which has a contract with Medicare and is affiliated with CVS Caremark™, the GIC’s pharmacy benefit manager.
Medicare Part D
Medicare Part D is Medicare prescription drug coverage that helps to cover the cost of prescription drugs for anyone who is eligible for Medicare Part A and/or Medicare Part B. It is provided through private insurance companies, health plans or employer plans like the GIC.
Who is covered by the GIC’s SilverScript plan
To be eligible for SilverScript sponsored by the GIC, you must:
- Be eligible for Medicare Part A for free and enrolled in Medicare Part B; and
- Live in the SilverScript service area which is the United States and its territories; and
- Be a GIC retiree, survivor, or a covered spouse/dependent of a GIC retiree; and
- Be enrolled in any GIC Medicare products
- Continue to pay your Medicare Part B premium, and if required by Medicare because of your income, the Part D surcharge (called the D-IRMAA); and
- Meet and maintain any of the GIC’s eligibility requirements for the plan.
How your income affects what you have to pay for your Medicare coverage
If your modified adjusted gross income reported on your federal tax return is above a certain amount, Medicare requires that you pay an extra amount for your Medicare coverage. It is called an Income-Related Monthly Adjustment Amount or IRMAA. For Medicare Part D, it is referred to as “D-IRMAA.”
For more info, please visit social security.
If you are disenrolled from SilverScript, you will lose your GIC medical, prescription drug and behavioral health benefits.
How to enroll in the GIC-sponsored SilverScript plan
You will automatically be enrolled in the GIC-sponsored SilverScript plan by the GIC if you are enrolled in a GIC Medicare plan.
What happens to your spouse or your dependent who is covered on your plan but is not eligible for Medicare
Your spouse will continue to be covered under in a GIC non-Medicare plan if he/she is under age 65 until he or she becomes eligible for Medicare.
What happens to your coverage if you are enrolled in another Part D plan
You can be enrolled in only one Medicare prescription drug plan at a time. If you are enrolled in another Medicare prescription drug plan or a Medicare Advantage plan with or without prescription drug coverage, you will be disenrolled from that plan when you enroll in a GIC Medicare plan.
Likewise, if you enroll in another Medicare prescription drug plan or a Medicare Advantage plan with or without prescription drug coverage, you will be disenrolled from the GIC-sponsored SilverScript plan. If you are disenrolled from SilverScript, you will lose your GIC medical, prescription drug and behavioral health coverage.
Extra Help is a Medicare program that helps individuals who have low income and resources to pay for prescription drug costs. For 2017, you may qualify if you have
- No more than $18,090 in income or $13,820 in resources for an individual
- No more than $24,360 in income or $27,600 in resources for a married couple
If Medicare identifies you as a person who qualifies for Extra Help to pay for your prescription drug costs, you will receive a letter from Medicare or the Social Security Administration.
Some people automatically qualify for Extra Help, for instance if they have full Medicaid coverage, get help from Medicaid to pay their Part B premiums or if they receive Supplemental Security Income (SSI) benefits.
To see if you qualify for Extra Help, you can:
- Call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Available 24 hours a day, 7 days a week.
- Go online at Medicare’s Website.
- Call Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778.
- Go online at Social Security’s Website.
How Extra Help works with your GIC coverage
If you qualify for Extra Help, your prescription drug costs will be reduced. Extra Help copays range from $0 to 15% coinsurance. The Low Income Subsidy Rider, which will be included with your SilverScript ID card, will tell you the exact amount of your copay or coinsurance.
Different Medicare Part D stages
The additional coverage provided by the GIC covers the gaps between Medicare Part D and your current coverage.
What to do if your drug is not on the formulary you receive from SilverScript
For drugs not listed on the formulary, call SilverScript at 1.877.876.7214 to find out if it is covered. TTY users should call 711. Some drugs are covered through the GIC’s additional coverage.
Preferred network pharmacies
SilverScript has preferred network retail pharmacies where you can get up to a 90-day supply of your maintenance medications for the same copay as mail-order. Current preferred network pharmacies include CVS Pharmacy®, Longs Drugs (operated by CVS Pharmacy) and Navarro.
Visit SilverScript’s website at SilverScript's website, or call SilverScript at 1.877.876.7214 to find the preferred network pharmacies near you. TTY users should call 711.
You may get your prescriptions filled at a pharmacy that is not part of SilverScript’s pharmacy network
Prescriptions filled at out-of-network pharmacies are only covered in an emergency. If you have any questions about whether or not your prescription will be covered at an out-of-network pharmacy, call SilverScript at 1.877.876.7214. TTY users should call 711.
If you use an out-of-network pharmacy, you will have to pay the full cost for your prescription and submit a paper claim available on SilverScript’s website and your itemized receipt to SilverScript for reimbursement.
You may continue to get your prescriptions filled at a Veterans Affairs (VA) pharmacy
VA pharmacies are not included in Medicare Part D plan networks. The federal government does not allow anyone to receive benefits from more than one government program at the same time.
However, if you are eligible for VA benefits, you may still use VA pharmacies under your VA benefits. Contact the VA Administration to find out the copay for the drugs you get filled at these facilities and also contact SilverScript for copays at participating SilverScript pharmacies so you can compare the two programs and determine the best option for you.
VA pharmacies are not included in Medicare Part D plan networks including SilverScript. The federal government does not allow anyone to receive benefits from more than one government program at the same time. However, if you are eligible for VA benefits, you may still use VA pharmacies under your VA benefits. Contact the VA Administration to find out the copay for the drugs you get filled and also contact SilverScript for copay details so you can compare the two programs and determine the best option for you. If you go to a retail pharmacy, such as CVS, Walgreens, or any other retail pharmacy, the claim will first process under your SilverScript Medicare Part D benefit, then it will process through TRICARE, where applicable. Questions concerning coordination of benefits, should be directed to TRICARE.
If you regularly travel overseas, you may need to prepare in advance of leaving the country
If you are traveling outside of the country, be sure to bring your prescription medications with you. Currently, Medicare Part D does not offer drug coverage outside of the country. You can call SilverScript at 1.877.876.7214 and request a vacation override for up to a 90-day supply before leaving the country. TTY users should call 711.
What happens if you need to get a prescription filled while you are out of the country
If you are traveling and need to fill a prescription, you should pay for the medication and save the itemized receipt. When you return to the country, send the itemized receipt with the completed SilverScript claim form (available at SilverScript's website) to the GIC and we will arrange to have you reimbursed for the cost of the prescription minus your copay, as long as the prescription is a covered drug and within the requirements of the plan design.
Late Enrollment Penalty for Medicare Part D
The Part D Late Enrollment Penalty (LEP) is the amount that Medicare requires a person to pay if he/she:
- Did not enroll in a Medicare prescription drug plan when first eligible for Medicare; or
- Did not have creditable prescription drug coverage – coverage at least as good as Medicare’s standard plan; or
- Had a break in coverage of more than 63 consecutive days.
The GIC’s retiree prescription drug coverage has always met or exceeded Medicare Part D coverage standard and has therefore been considered creditable coverage. See your health plan handbook for a Creditable Coverage notice.
If SilverScript contacts you, they may need information about your past prescription drug coverage to send to Medicare. Please make sure you provide the information requested in the notice. You may also ask that any decision about your late enrollment penalty be reconsidered.
The GIC will pay any Medicare Part D late enrollment penalty for the 2017 transition to SilverScript. But if you decide to cancel your GIC coverage in the future and enroll in a non-GIC Medicare Part D plan, you will be responsible for the Medicare Part D late enrollment penalty.
What you need to do if your drug can be covered under Part B or Part D
Certain drugs may be covered under Part B for some medical conditions and under Part D for other medical conditions. If you take a drug that could be covered under Medicare Part B or Medicare Part D, you will have to get a Part B or Part D determination before the drug can be filled.
Contact SilverScript at 1.877.876.7214. TTY users should call 711.
Medication Therapy Management
Medicare requires Medicare prescription drug plans to offer an optional, free service called Medication Therapy Management (MTM). If you take multiple medications, have a chronic condition or high drug costs, you may be invited to participate in a MTM program designed for your specific health issue. You may choose not to participate, but you should consider taking advantage of this free service. Contact SilverScript for additional details.
Who to call if you have any questions about Medicare Part D or SilverScript
If you have any questions about Medicare Part D or SilverScript, or you want to find out if your drug is covered or the location of network pharmacies near where you live or you are traveling, contact SilverScript at 1.877.876.7214, 24 hours a day, 7 days a week. TTY users should call 711.
Who to contact if you have questions about eligibility, how to enroll in the plan or your monthly health plan premium
If you have questions about eligibility, how to enroll in the plan, or your premium, contact the GIC at 1.617.727.2310, available 8:45 a.m. to 5:00 p.m., Monday through Friday. TTY users should call 711.