Enrolling in Medicare Part D
Who can enroll in Medicare Part D?
In general, individuals who have Original Medicare, Part A and/or Part B, or a Medicare Advantage plan (Medicare Part C) are eligible to enroll into a Medicare Part D Prescription Drug Plan.
In order to be eligible for Medicare Part D enrollment, you must:
- Have Medicare Part A and/or Part B.
- Live in the service area of a plan that provides prescription drug coverage.
Medicare prescription drug coverage is voluntary, and you will need to enroll. You can receive this coverage through private insurance companies in two ways:
- Medicare Prescription Drug Plan (Medicare Part D): These stand-alone Prescription Drug Plans can be added on to your Original Medicare coverage, as well as certain Medicare Cost Plans, Medicare Medical Savings Account (MSA) plans, and Medicare Private Fee-for-Service (PFFS) plans.
- Medicare Advantage Prescription Drug plan: Some Medicare Advantage plans include prescription drug coverage, in addition to providing Medicare Part A and Part B coverage.
Keep in mind that you cannot be enrolled in both types of plans. If you are currently enrolled in a Medicare Advantage plan that includes drug coverage and enroll into a Medicare Prescription Drug Plan, you will be automatically disenrolled from the Medicare Advantage plan and reverted back to Original Medicare.
You may choose to hold off on Medicare Part D prescription drug enrollment if you already have creditable prescription drug coverage, such as through an employer group plan. Creditable prescription drug coverage is coverage that is at least as good as standard Medicare prescription drug coverage. If you do not have creditable drug coverage for more than 63 consecutive days, you may have to pay a late-enrollment penalty if you decide to get Medicare prescription drug coverage at a later date. You may have to pay this late-enrollment penalty for as long as you have Medicare Part D.
How to enroll in Medicare Part D
Once you decide if you want to enroll into a Medicare Prescription Drug Plan or a Medicare Advantage plan that includes drug coverage, you can apply directly through the insurance company. Generally, you should be able to enroll by submitting a paper application, calling the plan, or enrolling online. You may also enroll through a licensed insurance agent such as eHealth. Medicare Part D Prescription Drug Plans aren’t allowed to call and ask you to enroll into their plan.
When you enroll in prescription drug coverage, you will have to provide your Medicare number and the date your Medicare Part A and/or Medicare Part B coverage started. You can find this information on your Medicare card.
When to enroll in Medicare Part D
There are specific times when you can enroll, disenroll, or make changes to your Medicare prescription drug coverage. Those periods are listed below.
Initial Enrollment Period for Part D
You can enroll in Medicare Part D coverage during your Initial Enrollment Period (IEP) for Part D, which is the period that you first become eligible for Medicare Part D. For most people, the IEP for Part D is the same as the IEP for Medicare Part B and begins three months before you turn 65 years of age, includes the month you turn 65, and ends three months after.
If you are not eligible to enroll in Medicare Part D because you do not live in a Part D-covered service area, your Initial Enrollment Period would not begin until three months before you permanently reside in the service area of a Medicare Part D Prescription Drug Plan or a Medicare Advantage plan that includes drug coverage.
If you enroll in Medicare Part D during your Initial Enrollment Period, your Medicare Part D coverage will begin on the first day of the following month that you apply for the plan. If you enroll in one of the three months prior to turning 65 years of age, your Medicare Part D coverage begins on the first day of the month that you turn 65.
Annual Election Period
If you do not enroll during your Initial Enrollment Period for Part D, you can enroll into prescription drug coverage during the Annual Election Period (AEP), also called Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage, which occurs from October 15 to December 7 of every year. During this time, you have the chance to make changes to your current Medicare prescription drug coverage for the following year, including:
- Enrolling into a Medicare Prescription Drug Plan.
- Switching from one Medicare Prescription Drug Plan to another Prescription Drug Plan.
- Switching from a Medicare Advantage plan that does not include drug coverage to a Medicare Advantage plan that does, and vice versa.
- Dropping your Medicare prescription drug coverage entirely.
Medicare Advantage Open Enrollment Period
If you have prescription drug coverage through a Medicare Advantage plan, you can choose to leave this plan and go back to Original Medicare during the Medicare Advantage Open Enrollment Period(OEP). If you disenroll from your Medicare Advantage plan at this time, you will have from January 1 until March 31 to enroll in a stand-alone Medicare Prescription Drug Plan, since Original Medicare doesn’t include prescription coverage.
5-Star Special Election Period (SEP)
Medicare Advantage plans and Medicare Prescription Drug Plans are rated on a scale of 1 to 5 for overall quality and performance, with a 5-star rating being “excellent.” The ratings are given by Medicare, based on member satisfaction surveys, as well as plan and provider feedback. The ratings may change from year to year.
If you are a member of a plan that does not hold a 5-star rating, you can use the 5-star Special Election Period to enroll in a Medicare Advantage with prescription drug coverage or a Medicare Prescription Drug Plan that has been awarded a 5-star rating outside of AEP. You can only use this enrollment period to enroll into a 5-star plan once per calendar year. This period runs from December 8 to November 30 of every year.
Special Election Period
Outside of the above times, the only time an individual eligible for Medicare can apply for, change, or opt out of a Medicare Part D Prescription Drug Plan is with a Special Election Period (SEP). Some special situations that may qualify you for an SEP include, but are not limited to:
- If you move out of your plan’s service area
- If your plan ends its contract with Medicare
- If you lose your creditable prescription drug coverage, or your plan changes and is no longer considered creditable
- If you live or move into an institution, such as a nursing home
- If you qualify for Extra Help
Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.