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Medicare Prescription Drug Coverage Q & A

Our mission at Lifestream pharmacy is to make it easier for consumers to understand the Medicare prescription drug program. Lifestream Pharmacy does not endorse any specific Medicare Part D plan. Lifestreamrx Pharmacy accepts ALL major Medicare prescription drug plans. The 2012 annual enrollment period is 10/15/11–12/7/11. Special enrollment periods that allow changes in Medicare Part D plans at other times of the year also may apply, depending on your circumstances.

Find answers to your questions about Medicare prescription plans:

What is Medicare prescription drug coverage?

The Medicare prescription drug benefit offers coverage for brand name and generic drugs to anyone eligible for Medicare. Coverage is provided through private insurance plans, and you can choose a plan that is right for you. You must enroll to get coverage.

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Am I eligible for the Medicare prescription drug plan benefit?

To be eligible for the Medicare prescription drug plan benefit, an individual must be:

  • Entitled to Medicare benefits under Part A and/or enrolled in Part B
  • A resident in the prescription plan's service area
  • Not be enrolled in more than one Medicare Part D plan at a time
  • Anyone eligible for Medicare prescription drug coverage may either enroll or switch to a different Medicare Part D plan during the October 15 to December 7 annual enrollment period.
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Should I enroll in a Medicare prescription drug plan?

You should enroll in a Medicare Prescription Drug Plan unless your current drug coverage is as good or better than the Medicare prescription drug coverage available to you. This is called "creditable" coverage. It's important that you join a plan when you are first eligible. You should contact your current plan provider to determine if you have creditable coverage. If you are eligible for Medicare and have Medicaid, you may be automatically enrolled in a prescription drug plan. Check with your State Medicaid Department for more information.

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When can I enroll?

You have the opportunity to obtain drug coverage when you become eligible for Medicare, during your initial Medicare enrollment period. You can join a Medicare drug plan:

During your initial 7-month Medicare enrollment period (three months before and three months after your 65th birthday)

During the three months before and the three months after your 25th month of disability

63 days after your creditable insurance coverage ends or during the annual enrollment period, which runs from October 15 to December 7 each year

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What if I choose not to enroll?

You may pay more: If you don’t join a Medicare drug plan when you’re first eligible to join (during your initial enrollment period) and there’s a period of 63 continuous days or more during which you don’t have creditable prescription drug coverage, you may have to pay a late enrollment penalty when you join. This amount changes every year, but is approximately 1% of the plan’s premium price for each month you delay in enrolling. In addition, you will have to pay a penalty as long as you have Medicare prescription drug coverage.

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Is there help available if I can't afford a Medicare prescription drug plan?

Some people with limited income and resources will qualify for Extra Help. If you qualify, Social Security will help you pay for premiums and/or the cost of prescriptions. You can apply for Extra Help at any time, and there's no risk to submitting an application. To determine if you qualify, contact your local Social Security office, or visit www.ssa.gov for more details. To qualify for this subsidy in 2012, Medicare-eligible seniors must meet specific income guidelines:

You may qualify for Extra Help if you have up to $16,335 annual income ($22,065 for a married couple) and up to $12,640 in total assets ($25,260 for a married couple.)

The "Extra Help" benefit will also help seniors by reducing or eliminating out-of-pocket deductibles, co-pays and expenses associated with the coverage gap.

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How do I prepare to choose a Medicare prescription drug plan?

Following these steps can help prepare you to make a decision:

  • Make a list of all of the prescription drugs you currently take.
  • Use the Medicare Plan Finder from www.medicare.gov to get a list of the plans that best meet your needs in the area you live.
  • Visit Lifestream pharmacy to ask questions or request additional information from your Lifestream pharmacist. Lifestream pharmacy doesn’t recommend any particular Part D plan, but we think it’s important for you to take advantage of the annual enrollment period to find the plan options that are best for you.
  • Apply for Extra Help if you have limited income and resources. There's no risk to submitting an application, and you can apply for Extra Help at any time throughout the year.
  • Be sure to complete the enrollment process by December 7!
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How do I find out if my medications are covered?

Use the Medicare Plan Finder at www.medicare.gov to find which medications are covered and the costs associated with each plan.

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When can I change plans?

You can change plans during the Medicare prescription drug program’s annual enrollment period, which is from October 15 to December 7 each year. Dual-eligible individuals — those with both Medicare and Medicaid — may change plans monthly, at any time throughout the year.

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Is the plan I'm on the best option for me?

If you're currently enrolled in a Medicare Part D plan, you should think about a few things to decide if you are in "the right plan." Each year, plan premiums, deductibles, prescription copayments and annual out-of-pocket expense can change. These costs, as well as the list of covered drugs, vary from plan to plan and from region to region. You also need to remember that, in general, only the cost of Part D covered drugs that are included on a plan's formulary count towards the deductible and out-of-pocket limits.

You should take time to review the various plans available to you in light of your current and anticipated prescription needs and financial resources. You may want to consider if there is a different plan available that may be more suitable to your needs. Use the Medicare Plan Finder at www.medicare.gov to help compare.

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Is there anything I can do to avoid the coverage gap (donut hole)?

Continuing in 2012, pharmaceutical companies will provide a 50% discount on brand-name drugs filled during the coverage gap. Additional savings on generic prescriptions also are available during the coverage gap.

The 50% discount on brand-name drugs works as follows: 50% from the pharmaceutical copay and 50% from the customer or beneficiary would be applied toward the total out-of-pocket cost through the coverage gap. So if a customer has a prescription drug that costs $400 a month at the agreed-upon price, $200 will be paid by the pharmaceutical company and $200 by the beneficiary but $400 will count toward the customer’s total out-of-pocket expense.

A word of caution: In order for the brand-name drug to be included, the pharmaceutical company must sign an agreement with Medicare. If there is no agreement for a particular drug, it is NOT entitled to the 50% discount.

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Where can I get more information?

Each year, Medicare recipients receive the “Medicare & You” handbook. It includes more detailed information and is a good place to start. You also can:

  • Visit your Lifestream pharmacy for help at any time
  • Compare plans using the Medicare Plan Finder at www.medicare.gov
  • Call 1-800-MEDICARE (1-800-633-4227)
  • Read about Medicare Prescription Drug Coverage and Your Rights

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Pharmacy Info

Jim Melekos
Pharmacist in Charge

P: 215.491.0999
F: 215.491.0977
» Email Us

Store Hours

SUN — Closed
MON - FRI — 9am - 7pm
SAT — 9am - 4pm

Delivery Info

Delivery Radius — 10 miles
Minumum Purchase — $6
Delivery Fees — $1