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2024 Medicare Prescription Drug Plan Benefit Details for the SilverScript Choice (PDP) - S5601-050
2024 Medicare Prescription Drug Plan Details
Medicare Plan Name:SilverScript Choice (PDP)
   by Aetna Medicare
State:Minnesota
Plan ID:S5601 - 050 - 0     Click to see other plans
Member Services:1-866-235-5660 TTY users 711
— This plan information is for research purposes only. —
Click here to see plans for the current plan year
Medicare Contact Information:Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options.
TTY users 1-877-486-2048
or contact your local SHIP for assistance
Email a copy of the SilverScript Choice (PDP) benefit details
— Medicare Plan Features —
Monthly Premium:$41.00 (see Plan Premium Details below)
Annual Deductible:$545
$0 Premium if LIS Benefits?Yes, this plan does qualify for the $0 Premium. (See premium for LIS subsidy beneficiaries below.)
Annual Initial Coverage Limit (ICL):$5,030
Drug Benefit Type ❔Actuarially Equivalent Standard (AE)
Additional Gap Coverage?No additional gap coverage, only the Donut Hole Discount
Total Number of Formulary Drugs:3,588 drugsBrowse the SilverScript Choice (PDP) Formulary
This plan has 5 drug tiers. See cost-sharing for all pharmacies and tiers. 
Insulin on a Medicare Part D plan's formulary will have a monthly copay of $35 or less.
Formulary Drug Details:Tier 1Tier 2Tier 3Tier 4Tier 5
• Preferred Pharmacy
  Cost-Sharing during
  initial coverage phase:		$2.00$7.0016%33%25%
• Number of Drugs per
  Tier:		32912032131231612
Plan Offers Mail Order?Yes
Medicare Plan Pharmacy Numbers: BIN: 004336   PCN: MEDDADV   See BIN/PCNs for all plans
Plan Type (Reach):National Plan
Number of Members enrolled in this plan in Minnesota:39,221 members
Number of Members enrolled in this plan in your CMS Region:110,192 members     (CMS Region 25)
Number of Members enrolled in this plan nationally:1,481,435 members
Plan’s Summary Star Rating: 3 out of 5 Stars.
• Customer Service Rating: 4 out of 5 Stars.
• Member Experience Rating: 3 out of 5 Stars.
• Drug Cost Accuracy Rating: 2 out of 5 Stars.
— Plan Premium Details —
The Monthly Premium is Split as Follows: ❔
Total
Premium		Part D Basic
Premium		Part D Supplemental
Premium
$41.00$41.00$0.00
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔ $0.00




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