Do you know when to enroll for Medicare Part D? Many people don’t, but you can!
Medicare prescription drug coverage (Part D) and general Medicare enrollment can be difficult to navigate. If you’re looking for some extra help to make sure you’re enrolling on time, look no further! This article will help you understand some of the ins and outs of Medicare Part D enrollment and ensure that you get the healthcare you need.
When Can I Sign Up for Medicare Part D: Initial Enrollment Period (IEP) or Annual Enrollment Period (AEP)?
The two most common and clear-cut windows for enrolling in Medicare Part D are during the Initial Enrollment Period and the Annual Enrollment Period. While each period serves different purposes, knowing the difference can help you keep track of when to enroll in Medicare Part D at the right time and without incurring a penalty.
Initial Enrollment Period
There are two different scenarios in which you can begin initial enrollment into Medicare Part D.
The first occurs when you turn 65 years old and are eligible for Medicare for the first time. If this is the case for you, the enrollment period lasts for seven months and begins three months before the month that you turn 65. The enrollment period ends three months after the month you turn 65. For example, if your 65th birthday lands in April, your enrollment period would begin in January and end in July.
The second scenario occurs when you gain eligibility by being less than 65 years old with a qualifying disability. Under these criteria, the enrollment window begins three months before your 25th month of receiving Social Security or Railroad Retirement Board benefits. This enrollment period ends three months after the 25th month of receiving those benefits. Should you enroll during or after the 25th month of receiving Social Security or Railroad Retirement Board benefits, your coverage will begin on the first day of the month after you ask to join a new plan. Otherwise, if you ask to join a Part D plan during the three months before your 25th month of receiving benefits, your coverage will begin on the first day of your 25th month.
Annual Enrollment Period
Every year, Medicare Part D has an open enrollment period that begins on October 15 and ends on December 7. During this time, you can also make changes to the current coverage of your health insurance plan, such as:
- Join or disenroll from a Medicare prescription drug plan
- Switch from one Medicare prescription drug plan to another
- Switch Medicare Advantage plans
Any changes to your Original Medicare plan made during this general enrollment period will go into effect on January 1 of the following year.
What about Part D Special Enrollment Periods (SEP)?
For those who want to enroll in a Part D prescription drug plan but are in circumstances outside of the initial and annual enrollment periods, you can still obtain Medicare Part D coverage if you:
- Are enrolled in both Medicare and Medicaid, your state helps pay for your Medicare premiums, or you get Extra Help paying for your Medicare prescription drug coverage.
- Recently obtained Extra Help, had a change in the level of Extra Help, or lost Extra Help.
- Involuntarily lost your creditable prescription drug coverage.
- Recently obtained Medicaid, had a change in the amount of Medicaid assistance, or lost Medicaid.
- Are leaving, losing, or joining an employer or union.
- Belong to a Pharmacy Assistance Program provided by your state.
- Moved outside of your plan’s service area.
- Have a plan that is ending its contract with Medicare, or vice versa.
- Recently left a PACE program (Program of All-Inclusive Care for the Elderly).
- Live in, are moving into, or recently moved out of a nursing home or long-term care facility.
- Are enrolled in a Medicare Advantage plan and want to make a change during the Medicare Advantage Open Enrollment Period (MA OEP).
- Would like to choose a different plan if you are already enrolled in a Medicare plan.
- Are affected by a weather-related emergency or major disaster (as declared by FEMA) or qualified for a special enrollment period, but you couldn’t make your enrollment because of the natural disaster.
- Were recently released from incarceration.
- Recently obtained lawful presence status in the United States.
- Recently returned to the United States after living abroad.
(Please note that the following does not include every scenario that allows for a special enrollment period. To see if you are eligible for special enrollment, please call Medicare at 1 (800) 633-4227. TTY users can call 1 (877) 486-2048.)
Are there any late enrollment penalties?
At the end of the Initial Enrollment Period, you may owe a late enrollment penalty if there’s a period of 63 or more consecutive days during which you have no Part D or other creditable prescription drug coverage. Typically, these late enrollment penalties will show up as higher monthly Part D premiums, and you will have to pay them for as long as you have a Medicare Part D plan. In addition, the more time that passes beyond the 63 days of late enrollment, the more expensive your penalty can be.
FAQ Signing Up for Medicare Part D
Do I have to enroll in any other Medicare Parts to enroll in Part D?
To enroll in a Part D plan, you must have already enrolled in Medicare Part A and Medicare Part B health plans. Also, you must live in the Part D plan’s service area.
What is creditable prescription drug coverage?
Creditable prescription drug coverage is typically obtained through insurance companies that provide coverage on behalf of employers or unions and is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.
Will incurring a Medicare Plan D late enrollment penalty cause me to have higher prescription drug costs?
Not directly. Your prescription drug costs will not be affected by a late enrollment penalty. However, your monthly premium will be more expensive.
Can I join a Medicare prescription drug plan if I have a Medigap policy with drug coverage?
No. You cannot have a Medicare prescription drug plan if you already have a Medigap policy with drug coverage. If you have a Medigap policy with drug coverage and would like to adopt one of the Medicare prescription drug plan options, you will have to inform your Medigap provider and have them make sure your Medigap drug coverage ends.
Conclusion: Enroll During the Appropriate Enrollment Periods
Though there are plenty of extenuating circumstances that would allow you to enroll outside of the initial or annual enrollment periods, it would be much better to sign up for Part D inside of the enrollment windows. There is no guarantee that your situation will qualify you for a special enrollment period, so mark the months and dates in your calendar! Remember that, for the initial enrollment period, you can enroll anytime in the three months before or after the month that you turn 65. For the annual enrollment period, you can enroll from October 15 to December 7.
If you have any other lingering questions or need more information, please visit Medicare.gov.