Medicare Part D Eligibility and Enrollment

• by Christian Worstell
• November 18, 2021
• Reviewed by John Krahnert

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 prescription drug plan? To compare plans where you live, you can call to speak with a licensed insurance agent. You can also compare Medicare Advantage prescription drug plans online for free.

You can also compare Part D plans and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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