Medicare Part D eligibility and enrollment

• by Christian Worstell

5 things to know about enrolling in a Medicare prescription drug plan:

1. There are established enrollment periods to add, change, or drop Part D coverage.
2. First-time Part D enrollees should apply during the 7-month Initial Enrollment Period.
3. The Annual Enrollment Period allows you to enroll, switch, or leave a Part D plan.
4. Special Enrollment Periods may let you sign up for a Part D plan outside of the main enrollment periods.
5. You may face a penalty for delaying Part D plan enrollment without creditable coverage.

In order to qualify for Medicare Part D coverage, you first must be enrolled in Medicare Part A and/or Part B.

Once you are eligible, you need to apply during a Part D enrollment period. If you do not sign up for a Part D plan when you are first eligible and you do not have creditable coverage, you may be required to pay a monthly late enrollment penalty once you do enroll.

If you already have a Medicare Advantage plan, you may not be eligible for a Part D plan, depending on the type of plan you are enrolled in. If you have a Medicare Advantage plan with drug coverage, you can't add a standalone prescription drug plan.

Part D enrollment periods

You must wait for an enrollment period to sign up for, make changes to, or leave a Medicare Part D plan.

If you need prescription drug coverage, it is important to enroll in a Part D plan during your Initial Enrollment Period (IEP) or when you are first eligible. If not, you may face a late penalty.

If your IEP ends and there is a period of 63 days or more in a row when you do not have creditable prescription drug coverage, you may have a late enrollment penalty added to your monthly premium for as long as you have Medicare prescription drug coverage.

Drug coverage is creditable if it pays – on average – at least as much as the standard Medicare prescription drug coverage.

Find your personal situation below to determine when you can enroll in, leave, or make changes to a Part D prescription drug plan.

If none of these situations apply to you, you may be able to qualify for a special enrollment period depending on your personal situation.

First-time Medicare Part D plan enrollees

You are 65 (or turning 65) and signing up for Medicare Parts A and B

You can join a Medicare prescription drug plan during your Initial Enrollment Period.

Your IEP is 7 months long. It starts 3 full months before the month you turn 65. It continues through the month of your 65th birthday, and then for another 3 full months.

Example: You turn 65 on June 5. Your IEP starts on March 1 (3 full months before June) and ends September 30 (3 full months after June).

If you are enrolling during your IEP, your coverage will start at the following times:

• If you are 65: the first day of the month after you ask to join a plan
• If you are under 65: the first day of the month you turn 65

You have Medicare Part A and are signing up for Part B during General Enrollment

You can enroll in a Medicare prescription drug plan between April 1 and June 30.

You are disabled and under 65

You can enroll in a Medicare prescription drug plan after you have been getting Social Security or Railroad Retirement Board benefits for 21 full months. After that point, you have 7 full months to enroll in a Medicare prescription drug plan.

Current Medicare Part D plan enrollees

You want to switch, make changes to, or drop your plan

You can make changes to your current Part D plan, switch plans, or drop your prescription drug coverage entirely during the annual fall Open Enrollment Period, which runs from October 15 to December 7 each year.

If you make changes during this time, your new coverage will begin on January 1 of the following year.

Special circumstances

In addition to the situations outlined above, you also may be able to add, change, or drop Part D plan coverage under special circumstances that qualify you for a Special Enrollment Period. The following are a few examples of situations that could qualify you for a Special Enrollment Period:

• Change in address or living situation
• Losing current coverage
• Opportunity for other coverage
• Your current Part D plan changes its contract with Medicare

Medicare.gov provides details for each Special Enrollment Period.

Apply for a Medicare Part D prescription drug plan

Are you looking to enroll in a Medicare Part D prescription drug plan?

You can compare Part D plans available where you live and enroll in a Medicare prescription drug plan online in as little as 10 minutes when you visit MyRxPlans.com.¹