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How to Navigate Medicare Part D Enrollment

Understanding when to enroll in Part D and what comes next

Reviewed by: Brett Braithwaite, Licensed Insurance Agent.

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Key Takeaways

  • 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, and you want to enroll in Part D. 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 a 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.

Should I Enroll in Medicare Part D?

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.

How to Sign Up for Medicare Part D

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. 

You can enroll in a standalone Part D plan or switch from Original Medicare to Medicare Advantage.

When Can I Apply for Medicare Part D?

There are two main enrollment periods for Part D coverage: Medicare Initial Enrollment PeriodThe initial enrollment period is a seven-month enrollment period when individuals, who are not automatically enrolled in Medicare, can sign up for Parts A and B. The period begins three months before your 65th birthday month, includes your birthday month, and continues for three months following your 65th birthday month. and Open Enrollment.Open Enrollment is the annual time period when individuals enrolled in Medicare Advantage plans can make a one-time plan change to any other Medicare Advantage, Medicare Advantage Part D, Part D plan or switch to Original Medicare. Medicare Open Enrollment is from January 1 to March 31. You can also enroll during the Special Enrollment PeriodThe Special Enrollment Period is a 60-day period outside the Open Enrollment Period when you can enroll or change your coverage. Special Enrollment Periods are only granted if you experience a Qualifying Life Event. These are special circumstances that may change your health insurance needs. 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, 2020. Your Initial Enrollment Period begins April 1, 2020 and ends October 31, 2020. 

 

Open Enrollment

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 [1]

What is the Late Enrollment Penalty?

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 your Initial Enrollment Period ended March 31, 2018. You waited until December 2019 to join a Part D plan during the Open Enrollment Period. Your plan went into effect on January 1, 2020, which means 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 $32.74 (2020 average Part D premium) = $6.90 ($6.88 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. [2]

What Happens After Enrollment?

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.

FAQs

Do I need Medicare Part D if I don’t take any medications?

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.

Can I switch my Part D plan?

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.

Where can I fill my prescriptions?

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.

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