As a Medicare beneficiary, you will not receive Medicare Part D prescription drug coverage instantly. Medicare Part D coverage is available and can help reduce the cost of medications. If you do not sign up for Medicare Part D Coverage when first eligible for coverage, a late-enrollment penalty may apply if you enroll after your deadline.
Most people are automatically enrolled in Original Medicare, Parts A and B when they turn 65. Original Medicare will not cover the majority of your medications, except for medications you might receive as a hospital inpatient or outpatient. Medicare Part B covers select prescription drugs that you get in an outpatient setting, like a physician’s office. However, these tend to be medications that you need a doctor to administer, such as infusion drugs.
To get help with most other medication costs, Medicare Part D coverage is available.
What Types of Medicare Part D Plans are Available?
Enrollment in Medicare Part D prescription drug coverage can be in two different ways, depending upon on whether you are enrolled in Original Medicare or a Medicare Advantage plan. A Medicare Advantage Plan, also known as Medicare Part C, is another way to obtain your Original Medicare benefits. Many plans also cover benefits beyond the federal program, including prescription drug benefits, dental, hearing, and vision coverage.
Medicare Part D prescription drug coverage is available:
- Through a stand-alone Medicare Part D Prescription Drug Plan. You can add this benefit to your Original Medicare by enrolling in any Part D Prescription Drug Plan that serves the coverage area where you live.
- Through a Medicare Advantage Prescription Drug plan (MAPD). You can sign up for a Medicare Advantage (Part C) plan that includes prescription drug coverage to receive all of your Medicare benefits under one plan.
How Do I Know If I’m Eligible?
To be eligible for Medicare Part D prescription drug coverage:
- You must be enrolled in Medicare Part A and/or Part B.
- You must live in the service area of a Medicare Part D Prescription Drug Plan
If you choose prescription drug coverage through a Medicare Advantage plan, you must have both Medicare Parts A and B, live in the service area of a Medicare Advantage plan, and not have end-stage renal disease. Not every Medicare Advantage plan covers prescription drugs, so confirm it with the plan being considered.
When Can I Enroll?
The best time to enroll in Part D is during the Initial Enrollment Period (IEP), which usually takes place during the same seven-month period as your IEP for Original Medicare. This is the seven-months starting three months before you turn 65, includes your birthday month, and ends three months afterward. The best time to sign up for Medicare prescription drug coverage is as soon as you enroll in Original Medicare.
You can also enroll in Medicare Part D coverage during the Annual Election Period (AEP), also referred to as Open Enrollment. This period is from October 15 to December 7, and during this time you are allowed to:
- Enroll in a Medicare Part D Prescription Drug Plan or change from one Prescription Drug Plan to another.
- Disenroll from your Medicare Prescription Drug Plan (if you’re already enrolled in one).
- Enroll in or switch Medicare Advantage Prescription Drug plans.
- Disenroll from your Medicare Advantage plan and return to Original Medicare.
After the AEP is complete, there is one more opportunity to make changes to your Medicare Part D coverage. If you are enrolled in a Medicare Advantage plan, you can use the Medicare Advantage Disenrollment Period (January 1 to February 14) to leave your Medicare Advantage plan and return to Original Medicare. Then, regardless of whether your Medicare Advantage plan included prescription drug coverage, you can also choose this same time period to enroll in a stand-alone Medicare Prescription Drug Plan. These are the only changes allowed during this time period.