The 7 questions to ask when enrolling in Part D for the first time

If you’re reading this, you’ve probably decided to enroll in Original Medicare Parts A and B. That’s one big decision out of the way! However, as you know, the list of decisions you still need to make is pretty long especially because there are some coverage gaps you may need to fill – most likely with a Part D plan (and possibly a Medicare Supplement plan, too).

There are a lot of Part D Prescription Drug Plans (PDP) to sift through, where do you start? Check out these questions to begin to determine the best plan for you. 

1. What is a Part D plan?

Part D plans are prescription drug plans that help to defray and cover the costs of prescription drugs. Prescription drugs are not covered under Medicare Parts A and B so in addition to a Medicare Supplement plan, a Medicare Part D plan often offers another component that can help more completely cover a Medicare beneficiary’s healthcare needs.

2. Where do I get a Part D plan?

Part D plans are available through private carriers. Speaking with a licensed insurance agent who represents multiple carriers can be a great way to evaluate prices and plan options in your area from a variety of different carriers.

3. When can I enroll?

The first time you can enroll is during your Initial Enrollment Period that begins three months before your 65^th birthday, continues through the month of your birthday and the following three consecutive months. You can enroll at the same time you enroll in Medicare Parts A and B, and your Medicare Supplement plan (if you want one).

4. There are a lot of plans available, how do I determine the best type of plan for me?

Of course, your current list of prescription medications is a great place to start in understanding how extensive you need your Part D plan to be. Make a list of every prescription drug you currently take and make note of whether or not the prescription is a brand name or generic option.

Check this list against the covered drug lists of the Part D plans you are evaluating. Each plan has a formulary, or its own list of drugs that it covers, with the amount charged per drug. It’s important to take a look at all the copays and costs for drugs that you are currently taking so that you get a sense of what the plan AND the costs of your regular medications will cost each year.

It is also important to note that no plan covers every single drug and copays may vary. You may be able to find lower out-of-pocket costs at specific pharmacies, depending on the plan.

5. Do I need a Part D plan? What if I don't take any prescription drugs right now?

Even if you don’t currently take any prescription drugs, it may be wise to enroll in a Part D plan at the same time you initially enroll in Original Medicare and get a Medicare Supplement plan. This would occur during your Initial Enrollment Period.

Should you choose not to enroll at this time — and don’t have other creditable drug coverage — you may be subject to a late enrollment penalty that will be assessed in your monthly premium payments for the rest of your life if you decide to enroll in a Part D drug plan later. Many people need to go on prescription drugs as they age, so even if you don’t need prescription drugs on your 65^th birthday, it may be advisable to consider a PDP during your IEP. You can always make adjustments to your plan during the Annual Enrollment Period that takes place each year from October 15 to December 7 if your prescription drug needs change from year to year. 

6. Can I be turned down for Part D coverage?

Simply stated: under no circumstance can you be turned down based on the current or past state of your health. You also can not be charged more for a plan based on your current or past health.

7. I've heard that Part D plans can change from year to year, what does that mean?

If this is your first time enrolling in Part D, you may be surprised by some of the variability in plans that you may experience each year. There are a few major things that can change from year to year: the formulary or list of prescription drugs that the plan covers and the costs assessed by the plan including premiums, deductibles and copays.

This is why it’s important to check your Part D plan coverage every year. Make sure you compare your current list of brand and generic prescription drugs against your plan’s new formulary and cost breakdown to see if you are still appropriately covered.

Now that you know some of the questions to ask and things to look for when evaluating a plan, it may be a good time to speak with a licensed insurance agent who can help you make a decision about a Part D plan that will work for your lifestyle.

Compare Medicare Prescription Drug plans in your area.

Get started by calling 1-800-557-6059 1-800-557-6059 TTY Users: 711 24 hours a day, 7 days a week.

About the author

Rebekah Etheredge is a licensed insurance producer in California and a regular contributor for MedicareAdvantage.com.

She has over six years of experience in the Medicare industry. She enjoys helping people learn about Medicare and finding the plan that fits their health needs and budget.

Rebekah is a graduate of Duquesne University with a bachelor’s degree in journalism. She currently lives in Crestline, CA.

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