• Started in 2006, the Medicare Part D program provides prescription drug coverage to Medicare beneficiaries.
• Each Part D plan will have a premium and cost-sharing for covered drugs.
• There are specific enrollment periods during the year for you to enroll in a Part D plan or change to a different plan.
Medicare Part D is coverage for retail prescription drugs that you obtain from a retail pharmacy. This voluntary program allows you to access medications at a more affordable rate. It also provides insurance against catastrophic drug costs.
You do not enroll in Medicare Part D via Social Security. Instead, you will choose a Medicare Part D plan offered by a private insurance company in your state.
Medicare Part D Enrollment
How Do I Enroll in Part D?
You must enroll in a Medicare Part D plan in the service area where you live. You can enroll in Part D directly with a Medicare Part D insurance provider or through an agent that specializes in Medicare products. Enrolling through an agent means you will have an extra resource for help when you have questions or problems with your drug plan.
You can also enroll in Medicare Part D via Medicare’s website or by calling Medicare at 1-800-MEDICARE.
Or call a licensed agent who can help you find best plan based on your drugs
Know that you can choose to have the Part D premium, which varies by plan, taken out of your monthly Social Security check, or you can pay your plan directly each month. If you choose to have your premiums withdrawn from your Social Security check, you may sometimes notice a delay in payment. However, your plan cannot disenroll you or bill you for the premium because of that delay.
Watch Video to Learn How, When, and Why to Enroll in Medicare Part D
When can I enroll in a Part D Drug Plan?
Joining a Medicare Part D drug plan can only be done during certain windows of time. You are eligible to enroll in Part D when you first get Medicare. This Initial Enrollment Period (IEP) lasts seven months.
It includes the three months before you turn 65, your birth month, and the three months following. A similar window exists for people who first become eligible for Medicare due to disability.
Medicare Part D also has an annual election period that runs from October 15 – December 7. During this time, you can enroll or disenroll from any drug plan. This is because each Part D plan’s benefits, formulary, pharmacy network, premiums, and/or co-payments/co-insurance may change on January 1 of the following year. Since all those things can change, Medicare gives you an annual election period to also change.
The insurance company will mail you an Annual Notice of Change each September. It will list everything that is changing with your plan for the following year.
If you are fine with the changes, your Part D drug plan will automatically renew in January. However, some people change their drug plans during the Annual Election Period if their prescription needs have changed and another plan better suits them.
Special Election Periods for Medicare Part D
Special Enrollment Periods for Medicare Advantage Plans
and Medicare Part D Drug Plans
You are limited in when and how often you can join, change or leave a Medicare Advantage Plan (also known as a Medicare
private health plan) or prescription drug plan (Part D).
• You can enroll in a Medicare Advantage or Part D plan during the initial period when you first qualify for Medicare.
• You can switch from your Medicare Advantage Plan to another MA Plan, or to Original Medicare with or without a Part
D plan, during the Medicare Advantage Open Enrollment Period (MA OEP). The MA OEP occurs each year from
January 1 through March 31. You can only use this period if you have a Medicare Advantage Plan.
• You can change your health coverage and add, drop, or change your drug coverage during Fall Open Enrollment. Fall
Open Enrollment occurs each year from October 15 through December 7.
Outside of the above three periods, you can only change your health and/or drug coverage if you qualify for a Special
Enrollment Period (SEP).
or each month you delay enrollment in Medicare Part D, you will have to pay a 1% Part D late enrollment penalty (LEP), unless you:
1. Have creditable drug coverage
2. Qualify for the Extra Help program
3. Prove that you received inadequate information about whether your drug coverage was creditable
In most cases, you will have to pay that penalty every month for as long as you have Medicare. If you are enrolled in Medicare because of a disability and currently pay a premium penalty, once you turn 65 you will no longer have to pay the penalty.
How do you calculate your premium penalty?
Let’s say you delayed enrollment in Part D for seven months (and you do not meet any of the exceptions listed above). Your monthly premium would be 7% higher for as long as you have Part D (7 months x 1%). The national base beneficiary premium in 2023 is $32.74 a month. Your monthly premium penalty would therefore be $2.29 ($32.74 x 0.7 = $2.29) per month, which you would pay in addition to your plan’s premium.
Note: The Part D penalty is always calculated using the national base beneficiary premium. Your penalty will not decrease if you enroll in a Part D plan with a lower premium.