Updated October 29, 2021
Reading time: 4 minutes
Do you know when to enroll for Medicare Part D? Many people don’t, but you can!
Medicare Part D coverage (PDP) enrollment is hard 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. It will also show you how to confidently choose the right prescription plan. Let’s get started.
Trying to save money on Medicare prescription drug plans? Try the Insurify Medicare comparison tool. Use it to find the best price on prescription plans in your area. Shop, compare, and save now!
The two most common and clear-cut windows for enrolling in Medicare Part D are during the:
Initial Enrollment Period
Fall Open Enrollment Period
Each period serves different purposes. Knowing the difference helps you enroll in Medicare Part D at the right time. And without incurring a penalty.
There are two windows to initially enroll in Medicare Part D.
The first occurs when you turn 65 years of age and are eligible for Medicare for the first time. If this is the case for you, the enrollment period lasts for seven months. It 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 is in April, your enrollment period begins in January and ends in July.
The second scenario occurs when you gain eligibility with a qualifying disability. The enrollment window begins the 22nd month you receive Social Security benefits. That goes for Railroad Retirement Board benefits. too. The enrollment period ends the 28th month of receiving those benefits.
If you enroll before the 25th month, your coverage will start on the 25th month. Should you enroll on or after the 25th month, your coverage begins on the first day of the month after you enroll.
If you’re already enrolled in Medicare Part D, you get a chance to make changes to your plan once every year.
Enrolled in Original Medicare? Changes during the general enrollment period go into effect on January 1 of the following year.
Enrolled in a Medicare Advantage plan? You can also make changes during Medicare Advantage Open Enrollment Period. This occurs from January 1 to March 31 every year. During MAOEP you can switch from a Medicare Advantage Plan to another.
What if you want to enroll in a Part D prescription drug plan but are the standard enrollment periods? You’d need to qualify for a Medicare Part D Special Enrollment Period. Circumstances that may qualify you for a SEP include:
You’re enrolled in both Medicare.
Medicaid, your state helps pay for your Medicare premiums.
You get Extra Help paying for your Medicare prescription drug coverage.
You recently obtained Extra Help, had a change in the level of Extra Help, or lost Extra Help.
You involuntarily lost your creditable prescription drug coverage.
You recently obtained or lost Medicaid.
You had a change in the amount of Medicaid assistance you qualify for.
You’re leaving, losing, or joining an employer or union.
You belong to a Pharmacy Assistance Program provided by your state.
You moved outside of your plan’s service area.
You have a plan that is ending its contract with Medicare, or vice versa.
You recently left a PACE program (Program of All-Inclusive Care for the Elderly).
You live in, are moving into, or recently moved out of a nursing home or long-term care facility.
You would like to choose a different plan if you are already enrolled in a Medicare plan.
You’re affected by a weather-related emergency or major disaster (as declared by FEMA)
You qualified for special enrollment, but couldn’t enroll because of a natural disaster.
You were recently released from incarceration.
You recently obtained lawful presence status in the United States.
You recently returned to the United States after living abroad.
This list does not include every scenario that grants 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.
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 coverage
Have no qualifying prescription drug coverage
Late enrollment penalties create higher monthly Part D premiums. You’ll also have to pay them for as long as you have a Medicare Part D plan. Plus, the more time that passes beyond the 63 days of late enrollment, the more expensive your penalty can be.
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.
Creditable prescription drug coverage is typically obtained through private 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.
Not directly. Your prescription drug costs will not be affected by a late enrollment penalty. However, your monthly premium will be more expensive.
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.
It’s always better to sign up for Part D inside of the enrollment windows. Yes, many circumstances allow you to enroll outside of your enrollment window. But, there is no guarantee you’ll qualify!
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 open enrollment period, you can enroll from October 15 to December 7.
And don’t forget that the Insurify Medicare comparison tool is always here to help! With it, you’ll find the best Medicare plan at the best price. Using just your ZIP code, you can uncover plan options in your area and compare them side-by-side. Try it today!
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Originally from Los Angeles, California, Adrian Coto is a writer living in Brooklyn, New York. A graduate of the NYU Creative Writing MFA program, he's worked as a legal assistant, a law school administrator, and now as a copywriter and editor.Learn More