How to Navigate Medicare Part D Enrollment
Reviewed by: Brett Braithwaite, Licensed Insurance Agent
There are two main enrollment periods for Part D coverage: Medicare Initial Enrollment Period and Open Enrollment.
The late enrollment penaltyThe Medicare Part D late enrollment penalty is a fee added onto your Part D premium if you go 63 consecutive days after your Initial Enrollment Period ends without creditable prescription drug coverage. The penalty generally applies for the lifetime of your Part D plan. is added onto monthly premiumsA premium is a fee you pay to your insurance company for health plan coverage. This is usually a monthly cost. if you go 63 days or more without creditable drug coverage, and don’t enroll during your Initial Enrollment Period.
Take your Medicare Card, Photo ID and your Part D plan membership card to the pharmacy the first time you pick up your prescription after enrolling.
You should consider all your options before you enroll in prescription drug coverage. Even if you don’t take a lot of medications currently, it could be beneficial to enroll in a plan during your Initial Enrollment Period.
You should consider Part D if you enroll in Original Medicare and you:
- Have a regular prescription drug need.
- Will have a prescription drug need in the future.
- Have trouble paying for your current prescription drug needs.
- Do not have prescription drug coverage.
- Want to avoid a late enrollment penalty in the future.
Find a local Medicare plan that fits your needs
After you have decided to join a prescription drug plan, it’s essential to understand the enrollment process. First, you need to enroll in Medicare. Then you can enroll in a Part D plan during a valid enrollment period.
- You join a Part D plan through a private carrier.
- You must live in the coverage area of the plan you select.
- You can enroll through Marketplaces like GoHealth.
There are two main enrollment periods for Part D coverage: Medicare Initial Enrollment PeriodThe Initial Enrollment Period (IEP) is the seven-month period around your 65th birthday when most people are eligible for the first time to enroll in Medicare. and Open Enrollment.The Medicare Open Enrollment Period (OEP), also known as the Annual Enrollment Period, runs from October 15 to December 7 each year and allows you to make multiple Medicare-related changes. In addition, Affordable Care Act Open Enrollment allows changes to non-Medicare coverage from November 1 to December 15. You can also enroll during the Special Enrollment PeriodA Special Enrollment Period is an opportunity outside of a standard enrollment period in which your specific circumstances allow you an opportunity to make changes to your Medicare-related coverage. if you qualify. Let’s take a look at the specific dates for when you can enroll.
Medicare Initial Enrollment Period
If you’re new to Medicare, you can enroll in a prescription drug plan during the seven-month Initial Enrollment Period.
- You can enroll three months before your 65th birthday month. Coverage begins the first day of your birthday month.
- You can enroll the month of your birthday. Coverage begins the first day of the month after your birthday.
- You can enroll three months after your birthday month. Coverage begins the first day of the month after enrollment.
For example: Let’s say you turn 65 on July 10. Your Initial Enrollment Period begins April 1 and ends October 31.
After your Initial Enrollment Period, you can enroll in Part D during Open Enrollment unless you qualify for a Special Enrollment Period. The Open Enrollment Period for Medicare and Part D is October 15 to December 7. Your new coverage starts in January.
Special Enrollment Period
The Special Enrollment Period is the only time you can enroll in a Part D plan outside of the Initial Enrollment Period and Open Enrollment.
You can qualify for the Special Enrollment Period if:
- You move outside of your plan’s service area
- You lose your current drug coverage
- Your plan terminates or changes its contract with Medicare
- You move into or out of a nursing home
- You qualify for Extra Help and more
Are you eligible for cost-saving Medicare subsidies?
The late enrollment penalty applies if you go 63 days or more without creditable drug coverage after your Initial Enrollment Period. Creditable drug coverage is required to cover the same costs as Medicare Part D. Employer group plans or unions usually provide those policies.
The penalty encourages Medicare beneficiaries to enroll in a Part D plan as soon as they are eligible. Even if you don’t take any medications when you enroll in Medicare, it may pay off to enroll in an inexpensive plan, so you have coverage when you need it.
Calculate the late enrollment penalty by multiplying 1% of the national average premium by the number of eligible months you went without Part D insurance. Then, round to the nearest ten cents.
Example: Let’s say you went 21 months without creditable coverage.
Here’s how to calculate the penalty:
.21 (multiply 1% by the number of months you went without coverage even though you were eligible to enroll) X $33.00 (projected average Part D premium) = $6.90 ($6.93 before rounding to the nearest 10 cents)
The penalty cost is likely to change each year because the national premium average fluctuates. The late enrollment penalty usually lasts the entirety of your Part D plan.
After you’ve joined a Part D plan and you’re ready to pick up your first prescription, you should take as much information as possible to the pharmacy.
You should bring:
- Your Medicare Card (red, white and blue)
- Photo ID
- Your Part D plan membership card
If you have more questions about enrolling in a Part D plan, connect with one of our licensed insurance agents. They will walk you through the process and help you enroll in the right plan.
What extra benefits and savings do you qualify for?
Part D is a voluntary program. Enrolling in a prescription drug plan depends on your situation. However, it’s important to consider joining a plan to protect yourself from high costs if you don’t have comparable drug coverage. You could face a lifetime late enrollment penalty, or you may have to wait until the Open Enrollment Period.
Yes, you can switch your Part D plan to a different drug plan during the Open Enrollment Period, or if you qualify for the Special Enrollment Period. If you decide to switch plans, you don’t need to tell your current drug plan because you will automatically be disenrolled when you join a new plan.
Your plan has a list of in-network pharmacies where you can fill your prescriptions. If you want to continue using your pharmacy, check to see if your pharmacy is on the plan’s list before enrolling in a policy. If you are a GoHealth member and have questions about where you can fill your prescription, reach out to our TeleCare team, and they can help you check.