How to Enroll in Medicare Part D to Get Prescription Drug Coverage
Medicare Part D is voluntary prescription drug coverage. Put simply, how you enroll in Medicare Part D depends on how you wish to receive your Medicare health benefits.
How to enroll in Medicare Part D: your choices
Before we get to how to enroll in Medicare Part D, here are a couple different ways you can get this coverage.
- If you have government-administered Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance), you can enroll in a stand-alone Medicare Part D Prescription Drug Plan.
- You might have another option – not only for getting prescription drug benefits, but for getting your Medicare Part A and Part B benefits. If you have Medicare Part A and Part B, generally you may enroll in a Medicare Advantage plan that includes prescription drug coverage. These types of plans are sometimes called Medicare Advantage Prescription Drug plans, and they combine health and prescription drug coverage.
Usually, if you have a Medicare Advantage plan, you can’t enroll in a stand-alone Medicare Part D Prescription Drug Plan. Most Medicare Advantage plans already include this coverage. However, you might be able to enroll in a stand-alone Medicare Part D Prescription Drug Plan if you are enrolled in Medicare Medical Savings Account (MSA), some Medicare Cost Plans, or some Private Fee-for-Service (PFFS) plans that don’t have prescription drug coverage.
What do Medicare Prescription Drug Plans have in common?
Before you enroll in Medicare Part D coverage, here’s a little more background about the types of Medicare Prescription Drug Plans.
Medicare-approved private insurance companies offer Part D prescription drug coverage. These companies must follow federal regulations regarding prescription drug coverage. They must be licensed in the states where they offer Medicare plans with prescription drug benefits and have defined, Medicare-approved service areas.
While stand-alone Medicare Part D Prescription Drug Plans and Medicare Advantage Prescription Drug Plans must provide coverage for certain classes of prescription drugs, they are not required to cover every medication in every class.
Each plan creates its own formulary, or list of covered medications. The formularies may vary from plan to plan and may change at any time. You will receive notice from your plan when necessary. Also, premiums and cost-sharing features such as deductibles, coinsurance, and copayments vary among plans.
How to enroll in Medicare Part D: know when you can sign up
In most cases, you may enroll in a plan that provides Medicare Part D coverage only during certain enrollment periods. These include:
- Your Medicare Initial Enrollment Period (IEP): the seven-month period that includes the three months before, the month of, and the three months following your 65th birthday. Your IEP may be different if you qualify for Medicare by disability before you’re 65.
- The Annual Enrollment Period (AEP), which occurs October 15th to December 7th: the time of year when you can make certain changes to your Medicare coverage.
- A Special Enrollment Period (SEP), which may occur because of personal circumstances, such as losing creditable prescription drug coverage from an employer group plan. The start date and length of the SEP depends on your situation.
- There is a new SEP called the Medicare Open Enrollment Period (OEP), which runs from January 1- March 31 annually starting in 2019. You may be able to enroll in a Medicare Advantage Prescription Drug plan, or switch from Medicare Advantage back to Original Medicare. If you switch back to Original Medicare, you can generally sign up for a stand-alone Medicare Part D Prescription Drug Plan during this period.
Note: If you live in a nursing home, you generally have the option of changing your Part D coverage. If you receive Extra Help, you may be able to enroll in a Medicare Prescription Drug Plan. Call Medicare for details (see the number at the bottom of this page).
How to enroll in Medicare Part D: evaluate your options
Once you’ve decided what type of Medicare Part D coverage you want, it’s time to compare plans and choose one that may fit your health needs and your budget.
Check to see if medications you take are on the plan’s formulary. Compare costs, including any applicable deductibles, copayments, and coinsurance amounts as well as monthly premiums. You can find and compare plans offering Medicare Part D coverage entering your ZIP code and clicking on the Get Started button on this page.
As for how to enroll in Medicare Part D coverage – after you click Get Started, you can apply for coverage as well.