If you are enrolled in Medicare Part A or Medicare Part B, you can join, switch or drop a Medicare Health Plan with drug coverage during the Initial Enrollment period, Open Enrollment Period or the Medicare Advantage Open enrollment.
You also have the right to have a Special Enrollment Period to enroll in a Medicare Part D plan under special circumstances, including losing employer drug coverage or receiving help through the Extra Help program.
How Do I enroll in Medicare Part D?
Getting prescription drug coverage is relatively easy, especially with help from a licensed insurance provider. Choosing a healthcare plan that includes assistance with prescription drug costs and coverage gaps is an important decision. When studying these plans, one of the first questions to ask yourself is what type you want: Medicare Prescription Drug Plan or Medicare supplemental insurance with prescription drug coverage?
Once you’ve done your research, you will need to provide your Medicare number as well as the date your Medicare Part A and/or Part B began to the insurance provider of your choice. This is all information you can find on your Medicare card.
What I Need to Know to Enroll in Medicare Part D
Enrolling in Medicare prescription drug coverage will provide you with various benefits, including lower prices and better service through private plan options. It’s essential to look at all the costs before choosing your plan. Your monthly premium may be waived if insurers determine you as having limited income or resources; however, an enrollment fee must usually be paid upfront for this waiver benefit.
Aside from the costs and the prescription drugs covered within the plan, the most critical piece of information you need to enroll in Medicare Part D is when to do it.
Initial Enrollment Period for Part D
The Initial Enrollment Period is your earliest opportunity to enroll, starting three months before you turn 65.
The IEP for Part D will generally be the same as for Part B: the seven-month period, which includes the three months before the month a person becomes eligible for Medicare, the month you are eligible, and three months after you become eligible. So, for example, if you become eligible for Medicare when you turn 65 on May 15th, your IEP will be from February 1st to August 31st.
If you join a Medicare drug plan during the three months before you become eligible for Medicare, your coverage will start the month you become eligible.
If you join a Medicare drug plan during the month, you become eligible, or during the three months afterward, your coverage for prescription drugs will start the first month after you enroll. It would be best to enroll early during your IEP to ensure that your coverage will begin as soon as you become eligible.
If you missed the deadline for signing up for Original Medicare during the IEP or SEP, you could do so during the general enrollment period from January 1st to March 31st. You can then enroll in a Part D drug plan between April 1st and June 30th.
Annual Election Period
The Annual Election Period period is from October 15th to December 7th. It gives you the chance to make changes like changing your plan or disenrolling from your current one.
The Annual Election Period, also known as Fall Open Enrollment, is your annual opportunity to enroll or change your Medicare Part D coverage. From October 15th to December 7th, you can enroll in a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan for the first time, switch plans, or disenroll entirely.
Special Election Period
If you have a qualifying life event, you can enroll during a Special Election Period.
Examples of qualifying events include:
- You recently obtained, lost or had a change in the level of Extra Help.
- You lost your creditable prescription drug coverage to no fault of your own through your employer, union, retiree benefits, COBRA, Medicaid, or the Veterans Affairs health care program.
- You recently received or lost Medicaid.
- The Medicaid assistance you qualify for has changed.
- You’re retiring, losing, or joining an employer or union.
- You belong to a Pharmacy Assistance Program in your state.
- You moved outside of your current plan’s service area.
- You have a plan that is ending its contract with Medicare.
- You recently left a PACE program.
- You are moving into or out of a nursing home or long-term care facility.
- You’re affected by a FEMA emergency or disaster.
- You qualified for special enrollment but couldn’t enroll due to a natural disaster.
- You were recently discharged from incarceration.
- You recently returned to the United States after living abroad.
This list does not include every scenario that grants a special enrollment period. We encourage you to visit Medicare.gov for more information.
5-Star Special Election Period (SEP)
The SEP enrollment period runs from December 8th to November 30th of every year.
If you’re not a member of a plan with a 5-star rating, use the special election period to enroll in one through private insurance companies. You may only do this once per year, and you can only switch to a 5-star Medicare Prescription Drug Plan if one is available in your area.
Medicare Advantage Open Enrollment Period
The Medicare Advantage Open Enrollment Period (OEP) takes place between January 1st and March 31st. You can enroll in a Medicare Drug Coverage during this time.
If your prescription drug coverage is through a Medicare Advantage plan, you can choose to leave your plan and go back to Original Medicare during OEP. If you decide to disenroll, you can enroll in Medicare Part D from January 1st to March 31st.
Medicare Part D FAQ
What is creditable prescription drug coverage?
Beginning January 1st, 2006, Medicare beneficiaries had the chance to obtain subsidized prescription drug coverage through the new Medicare Part D program. According to CMS.Gov, “If their other coverage is at least as good as the new Medicare drug benefit (and therefore considered “creditable coverage”), then the beneficiary can continue to get the high-quality care they have now as well as avoid higher payments if they sign up later for the Medicare drug benefit.”
If you want to avoid the Medicare Part D prescription drug plan late enrollment penalty, make sure your drug coverage is creditable. For a plan to be eligible as credible insurance (required by Medicare), it must provide at least one of these benefits:
- Hospitalization and medical expenses.
- Major medical expense protection or health-related services like vision care, dental work, prescription drugs after the deductible has been met.
- Limited out-of-network coverage in other states when travelling outside of their home state.
Your employer or union will tell you if your drug coverage is creditable each year. Keep the information and call them before making any changes to find out more.
What Happens if I Enroll Late into Medicare Part D Coverage?
Even if you’re not taking prescription medications right now, it’s a good idea to enroll in Medicare Part D straight away.
The first opportunity to enroll in Medicare Part D is once you have Medicare Part A and/or Part B, which is possible three months before your birthday month and three months after. If you don’t enroll in Medicare Part D during this period, you could face a late-enrollment penalty that is permanently added to your premiums when you enroll. You will not receive any penalties regarding the cost of your prescriptions.
Can I Join a Medicare Prescription Drug Plan if I Have Drug Coverage Already?
When you sign up for Medicare Part D, it means that your Medigap policy with drug coverage will stop. If you have a Medigap policy with drug coverage and want to adopt one of the Medicare prescription plan options, please contact your insurer or go into their office to end this in time.
Should I Sign Up For Any Insurance with Part D?
Everyone should sign up for Medicare Part D; however, taking the time to research is incredibly important as all programs vary slightly. We encourage you to speak with a licensed insurance professional at Coverage Haven to find the appropriate plan for you.