What is Medicare Part D?

Medicare Part D is a prescription drug plan offered by Medicare. Its purpose is to cover the majority of the expenses associated with prescription medications.

Who Qualifies for Medicare Part D?

Anybody who qualifies for Original Medicare is eligible to enroll. When a person turns 65 years of age, they automatically qualify for Medicare. Individuals below the age of 65 may also qualify for Medicare if they have a qualifying disability.

Is There a Specific Enrollment Period for Medicare Part D?

Yes, there is an enrollment period for Medicare Part D. Your initial enrollment period coincides with your Medicare enrollment period surrounding your 65th birthday. You become eligible for enrollment three months before your birthday, and your enrollment period continues throughout your birthday month and three months thereafter.

Are There Any Penalties if I Miss the Enrollment Period?

Yes, late enrollment penalty will be assessed if you go more than 63 days beyond your initial enrollment period without drug coverage.

Note: If you qualify for an extra help program, you will not be charged a penalty.

How is the Late Enrollment Penalty Figured?

For each month you go without coverage after your enrollment period has ended, you are charged 1% of the National Base Beneficiary Premium. In 2023, that amount is $32.74 per month. Assume your enrollment period ended in January of this year and you did not enroll in a prescription drug plan. Now assume that you wait until the next open enrollment season for Medicare, which begins on October 15. You decide to enroll in Medicare Part D on November 1. You would have gone nine months without coverage. Therefore, you will be charged 9% of $32.74 – which is $2.9466. That amount will be rounded to the nearest $0.10 in either direction and added to your monthly premium. In this case, your penalty would be $2.90 per month.

Will I Always Have to Pay the Monthly Penalty?

Yes, you will continue to pay the penalty every month in most cases. Generally speaking, once Medicare has determined a late enrollment penalty for a Medicare Part D prescription drug plan, that penalty will apply to the monthly premium as long as the member is enrolled.

Is There an Alternative to Medicare Part D?

Yes and no. You can choose a Medicare Advantage Plan. Medicare Advantage Plans are popular alternatives to Original Medicare. And most Medicare Advantage Plans come with a Part D plan.

Can I Enroll in Medicare Part D if I Already Have Prescription Drug Coverage Through Another Health Insurance Provider?

Yes, in many cases, you can enroll even if you have another health insurance provider. It’s important to note, however, that if you decide to enroll in a Medicare Advantage Plan, you are no longer eligible.

Medicare Part D may share expenses with plans such as Medicaid, an employer-sponsored plan, a private insurance plan, or a veteran or military-specific health insurance plan that provides coverage for prescription drugs. Once you enroll, your health insurance companies will decide which will be the primary payer and the secondary payer.

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