Medicare Part D Enrollment Period – Prepare For It Now
Original Medicare does not cover prescription drugs, with the exception of a select set of drugs that are typically administered in a clinical setting, such as chemotherapy treatments.
But for the kind of medications that you get at a pharmacy counter yourself, you have to buy private drug coverage to cover the cost. You can do this with a standalone Part D drug plan or a Medicare Advantage plan with prescription drug coverage included.
Like with other parts of Medicare, there are certain times during the year when you can get prescription drug coverage. Here’s what you need to know about enrolling in Medicare Part D.
Initial Enrollment Period for Medicare Part D
Your initial enrollment period for Medicare Part D depends on how you qualify for Medicare in the first place. Specifically, when you can first get Part D is based on one of these scenarios:
- Age (65+)
- Disability (under 65 and receiving disability benefits from Social Security or the Railroad Retirement Board)
- Disability and age (65+ and with a disability)
- When you enroll in Medicare Part A and/or B for the first time
Everyone who’s new to Medicare has an Initial Enrollment Period (IEP) that lasts for a total of 7 months. For people who don’t qualify based on disability, the IEP starts three months before the month you turn 65 and ends three months after that month. So, for example, if your birthday is June 11th, your IEP runs from March 1st through September 30th the year you turn 65.
During this IEP, you can also enroll in a standalone Part D drug plan or a Medicare Advantage plan that covers prescription drugs (but not both).
Your initial signup window is the best time to get prescription drug coverage. Outside of the IEP, you can add Part D later during certain times of the year, but you may owe a penalty fee for enrolling in Part D late. And that penalty fee lasts for as long as you have Part D coverage — i.e., forever.
Here’s when your plan will start based on when you sign up during the IEP:
- If you enroll in the first three months before the month you turn 65, your Part D coverage will start the month you turn 65. Example: your birthday is June 11th. Your IEP runs from March 1st to September 30th. If you join between March 1st and May 31st, your coverage starts on June 1st.
- If you enroll during your birthday month or during the three months after, your Part D coverage will start on the first day of the month after you ask to join the plan. Example: your birthday is June 11th. Your IEP runs from March 1st to September 30th. If you join on June 14th, your coverage starts on July 1st. If you join on July 23rd, your coverage starts August 1st.
For people who qualify for Medicare based on disability and who haven’t turned 65 yet, initial enrollment for Part D works differently. In this case, you’ll be able to enroll in Part D for a total of 7 months, just like people who qualify based on age, but the time period is different.
Instead, you can enroll starting three months before the 25th month of your disability payments from Social Security (or the Railroad Retirement Board) and ending three months after that month. If, for instance, your 25th month of disability payments is in April, your initial signup window for Part D and Medicare Advantage runs from January through July of that year.
If you qualify based on disability, here’s when your plan will start based on when you sign up:
- If you enroll in the first three months before you first get Medicare (starting the 22nd month of disability), your Part D coverage will start the month you get enrolled into Medicare (25th month of disability). Example: your 25th month of disability is September. You enroll in Part D on July 8th. Your coverage begins September 1st, the same month your Medicare benefits begin.
- If you enroll during the 25th month of disability or during the three months after, your Part D coverage will start on the first day of the month after you ask to join the plan. Example: your 25th month of disability is September. You enroll in Part D on September 15th. Your Part D coverage starts on October 1st. If you enroll in November, the coverage doesn’t start until December 1st.
Disability and age
If you’re already getting disability benefits and then qualify for Medicare based on age (turning 65), you’ll follow the same IEP rules as someone aging into the program who doesn’t have disability status.
In other words, you’ll have the same 7-month initial signup window that runs for 3 months before the month you turn 65 and ends three months after that month.
Coverage will take effect based on when you enroll using the same IEP rules we mentioned above.
When you enroll in Part A and/or Part B
The best time to enroll in Medicare is when you’re first eligible. But if for whatever reason you delay enrollment, you can use the General Enrollment Period (January 1st through March 31st) to sign up for Part A and/or Part B for the first time.
If you do this, then you can use a special spring enrollment period to get Part D for the first time, too. This special signup period runs from April 1st through June 30th.
If you enroll in Part D during this time period, your coverage starts on July 1st.
Medicare Open Enrollment
If you already have Medicare, either Original or a Medicare Advantage plan, then you can use the annual Medicare Open Enrollment Period to add, change or remove Part D coverage. It runs from October 15th through December 7th each year and allows everyone with Medicare to make changes to their coverage for the upcoming year.
For Part D, this means you can:
- Enroll in a new Part D drug plan;
- Change your current Part D coverage to something else;
- Change from a Medicare Advantage plan without drug coverage to one with drug coverage (or vice versa); or
- Drop Part D altogether
If you use the Medicare OEP to sign up for a drug plan for the first time, then you may owe a penalty fee for enrolling in Part D late — i.e., outside of your initial enrollment window. That penalty is calculated using a special formula and it lasts for as long as you have Part D coverage.
So if you think you need Part D coverage at all, the best time to enroll is when you’re first eligible.
But the open enrollment period gives you a good opportunity to update your coverage for the next year. You may save money by shopping and comparing plans.
Any changes that you make to your Medicare coverage during open enrollment take effect on January 1st.
Medicare Advantage Open Enrollment Period
If you already have Medicare Advantage, then another open enrollment period is available to you as an MA member. It’s called the Medicare Advantage Open Enrollment Period and it runs from January 1st through March 31st each year. Yes, it runs simultaneously with the general enrollment period we highlighted earlier, but in this case, the MA OEP is specifically for people who already have Medicare Advantage.
During the MA OEP, you can make a one-time change to your coverage. This is not the same as the open enrollment period for everyone with Medicare, during which you can make as many changes as you need until enrollment ends. The Medicare Advantage OEP allows a one-time change.
You can only make certain changes during this enrollment period, like going from an MA plan with drug coverage to one without, or vice versa. You can also drop Medicare Advantage and switch back to Original Medicare, and if you do this, you’re also allowed to enroll in a Part D drug plan at the same time.
Any change you make during this period will take effect on the first of the month following the month you make the change. So, for example, if you switch from one MA plan to another in February, that new plan will start on March 1st.
Part D Special Enrollment Periods
Now that we’ve covered the basic enrollment periods for Medicare Part D, we want to mention that there may be other times you can enroll in a Part D drug plan. These are called special enrollment periods, and they vary depending on your situation.
You might get a special enrollment period for things like:
- Losing your current coverage
- Gaining access to other drug coverage
- Qualifying for Extra Help
- Administrative errors
This list isn’t exhaustive. There’s a wide range of situations that might qualify you to enroll in Part D outside of your initial signup window or an official enrollment period. If you think you qualify for a special enrollment period, contact Medicare directly.
Finally, there’s also a 5-Star Special Enrollment Period. The Centers for Medicare and Medicaid Services (CMS) rates private plans (Medicare Advantage and standalone drug plans) on a scale of 1 to 5, with 5 being the highest rating. These ratings are based on a variety of factors and are updated each year.
The 5-star SEP allows you to switch to a 5-star rated Medicare Advantage or Part D plan if it becomes available in your area. You can use this special signup period only once between the period of December 8th and November 30th.
Eligibility for Medicare Part D
If you’re eligible for Medicare, then you’re eligible for Medicare Part D. This portion of Medicare is designed to help people with Medicare cover the cost of prescription drugs.
Medicare Part D might not be your only option for drug coverage, though. Older enrollees may have access to programs that have since been eliminated, like drug coverage through Medigap (available before 2006). Or you may have other benefits available to you, like retiree coverage or a military benefits program, such as TRICARE.
But if you have no other options and need prescriptions, Medicare Part D offers an affordable way to get some of your costs covered at the pharmacy counter.
Just make sure that when you’re first eligible for Part D, you look into all of your options carefully. Enrolling on time (during your initial enrollment period) will help you avoid a potential penalty fee for late enrollment. If you need help, contact Medicare directly or a licensed agent who can walk you through your options and get you the plan you need.