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Silverscript disenrollment form 2025

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The document is a disenrollment form for SilverScript Choice (PDP), a Medicare Prescription Drug Plan. It provides instructions for members wishing to disenroll, including the option to call Medicare directly. The form requires personal information and includes an attestation of eligibility for an election period, outlining specific circumstances under which disenrollment may occur outside the annual enrollment period. It also emphasizes the importance of continuing to fill prescriptions until disenrollment is effective and warns about potential late enrollment penalties.

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Click ‘Get Form’ to open the silverscript disenrollment form in the editor.
Begin by entering your Last Name, First Name, and Middle Initial in the designated fields. Select your title (Mr., Mrs., Miss, Ms.) to personalize your application.
Fill in your Member ID and Birth Date accurately. Indicate your sex by selecting either 'M' for male or 'F' for female.
Provide your Home Phone Number, ensuring it is correct for any follow-up communications regarding your disenrollment.
Read the agreement carefully before signing. Your signature confirms that you understand the implications of disenrolling from SilverScript Choice (PDP).
If applicable, complete the section for authorized representatives by providing their name, address, phone number, and relationship to you.
Review all entered information for accuracy before submitting the form through our platform.

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2019	4.8 Satisfied (41 Votes)
2016	4 Satisfied (41 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Is SilverScript going away?

SilverScript SmartSaver and SilverScript Plus will not be offered in 2025; enrollees in these plans will be crosswalked to SilverScript Choice in 2025. At most, stand-alone drug plan premiums are increasing by $35 per month over 2024 levels, due to the premium stabilization demonstration.

Can I cancel my Part D drug plan?

As a Medicare beneficiary and a plan member, you have the right to request disenrollment from your Medicare Part D prescription drug plan.

What insurance is SilverScript under?

The SilverScript Choice PDP from Aetna Medicare SilverScript Choice offers a wide range of brand and generic drugs. There are more than 1,400 drugs on the Aetna SilverScript formulary (drug list).

Are Aetna and SilverScript the same?

Aetna Medicare | Your plan name is now SilverScript SmartSaver (PDP.

How do I opt out of MHBP SilverScript?

If you dont want to be enrolled in the SilverScript Employer PDP for MHBP, you must contact Member Services at 1-833-825-6755 (TTY: 711), Monday through Friday 8 AM8 PM ET or go online at AetnaRetireeHealth.com/MHBP.

how to cancel aetna silverscript prescription drug plan

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What insurance company owns SilverScript?

Who Owns SilverScript? SilverScript partnered with Aetna in 2021 for fuller Medicare coverage, but Aetna (and therefore SilverScript) are owned by CVS Health.

How do you cancel SilverScript?

How to drop your Medicare drug plan Call us at 1-800 MEDICARE (1-800-633-4227). TTY: 1-877-486-2048. Mail or fax a signed written notice to the plan telling them you want to disenroll. Submit a request to the plan online, if they offer this option. Call the plan and ask them to send you a disenrollment notice.

Silverscript disenrollment form 2025

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See more silverscript disenrollment form versions

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Got questions?

Is SilverScript going away?

Can I cancel my Part D drug plan?

What insurance is SilverScript under?

Are Aetna and SilverScript the same?

How do I opt out of MHBP SilverScript?

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What insurance company owns SilverScript?

How do you cancel SilverScript?

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