Medicare Expert Q&A: Am I Required to Enroll in Medicare Prescription Drug Coverage?

Medicare expert Christian Worstell explains that drug coverage isn't required, but you may face penalties if you don't enroll when you're first eligible and decide you want it later.

In this Q&A series, Medicare expert Christian Worstell answers your questions about Medicare coverage, benefits, eligibility, enrollment and more. Christian is a licensed insurance agent and frequent contributor to MedicareAdvantage.com.

Have a question for Christian? Ask it here.

"I don’t like to take many prescription medications because of potential side effects and the risk of addiction to things like pain killers. I’m in really good health for my age (64). Will I be required to pay for prescription drug coverage once I am on Medicare?" – Patricia K., Youngstown, OH

Hi Patricia, thanks for writing. To answer your question, no, you are not required to sign up for Medicare prescription drug coverage if you do not want it. 

You should note, however, that you may face a late enrollment penalty if you forego Medicare prescription drug coverage now and decide to sign up at a later date (and don’t have some other form of creditable prescription drug coverage).

The Part D late enrollment penalty is an extra fee that’s added to your monthly Part D premium, and you have to pay the penalty for the rest of the time that you have Medicare drug coverage.

Prescription drugs are not typically covered by Original Medicare (Medicare Part A and Part B). If you want Medicare prescription drug coverage, you can enroll in one of the following:

  • A standalone Medicare Part D plan, often referred to as a PDP, which provides coverage exclusively for prescription drugs.

  • A Medicare Advantage Prescription Drug (MA-PD) plan, which is a plan that offers Original Medicare benefits along with coverage for prescription drugs. Some MA-PD plans may also offer other benefits that Original Medicare doesn’t cover, such as routine hearing and dental benefits, transportation, home meal delivery and more.

Part D plans and Medicare Advantage plans that provide prescription drug coverage are entirely optional and you do not have to purchase drug coverage if you don’t want it.

However, there are two reasons I advise you to consider enrolling in either option:

  • The first reason is that although you may be in good health now, we never know what the future may hold.

    There are some health conditions that you may potentially face that will require you to take prescription medication. Depending on the condition being treated and the drugs prescribed, the out-of-pocket costs for medicine can add up quickly. 

  • The second reason is cost. In some parts of the country, Medicare Part D plans may feature premiums of less than $20 per month,1 and many MA-PD plans offer $0 premiums.2

    Costs may vary from one location to another, so it’s good to thoroughly compare your plan options before you enroll, either online or by calling to speak with a licensed insurance agent. 

So to wrap it all up, no, you are not technically required to purchase Medicare prescription drug coverage. Around 70 percent of Medicare beneficiaries are enrolled in Medicare drug coverage, however, and many likely do so because of at least one of the reasons listed above.3

How do I find the best Medicare drug plan for my needs?

A licensed insurance agent can help you compare Medicare Advantage plans and Medicare prescription drug plans that are available in your area. They can help you explore important factors such as the costs of each plan, what pharmacies near you are accepted by the plan and how much your drugs cost with the plan.

You can also compare plans online for free, all from the comfort of your home and with no obligation to enroll.

Compare Medicare plans in your area

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Or call TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

 

1 Jacobson G, et al. (Oct. 24, 2019). Medicare Advantage 2020 Spotlight: First Look. Kaiser Family Foundation (KFF). Retrieved from https://www.kff.org/report-section/medicare-advantage-2020-spotlight-first-look-data-note.

2 Cubanski J, Damico A. (Nov. 14, 2019). Medicare Part D: A First Look at Prescription Drug Plans in 2020. KFF. Retrieved from https://www.kff.org/medicare/issue-brief/medicare-part-d-a-first-look-at-prescription-drug-plans-in-2020.

3 Cubanski J, et al. (June 4, 2019). 10 Things to Know About Medicare Part D Coverage and Costs in 2019. KFF. Retrieved from https://www.kff.org/medicare/issue-brief/10-things-to-know-about-medicare-part-d-coverage-and-costs-in-2019.