Prescription drugs can either be something you spend nearly no money on, or something that ends up being so incredibly expensive that it threatens your financial stability. Coverage for prescription drugs in Medicare is called Part D, but not everybody is eligible for this. The following page will help you understand what it takes to be eligible for Part D of Medicare, along with some additional information and resources that you may find useful.

Eligibility Requirements for Part D

If you are eligible for Original Medicare (Part A and B) you should be eligible for Medicare Part D. In order to be eligible for Original Medicare you must be: 

  • Age 65 or older 
  • Under age 65 with certain disabilities 
  • Any age with End Stage Renal Disease 

Note: If you are receiving Social Security or Railroad Retirement Board benefits you will be automatically enrolled into Original Medicare Part A and B.

Who Should Enroll? 

If you’re eligible for Original Medicare, it’s recommended that you join a prescription drug plan during your Initial enrollment Period unless you have creditable prescription drug coverage elsewhere. If you don’t have any prescription drug insurance and you wait to enroll, Medicare may charge a late enrollment penalty which will be added to your monthly premium. You should enroll in Medicare Part D if:

  • You have one or more monthly prescriptions
  • You do not have creditable prescription drug coverage
  • You are worried about the cost of prescription drugs
  • You currently struggle to pay for prescription drugs 

When to Enroll 

Initial enrolment Period (IEP)

Unlike Original Medicare, you will not be automatically enrolled into a prescription drug plan. To avoid a late penalty fee, it’s recommended that you sign up for Part D during your Initial enrolment Period which begins three months before your 65th birthday and ends three months after you turn 65 for a total of seven months. 

Note: If you currently have creditable prescription drug coverage (coverage that is similar or better than a basic Medicare prescription drug plan) you won’t have to pay a late penalty fee as long as you don’t go longer than a period of 63 days without coverage. 

Special enrollment Period (SEP)

If you have creditable prescription drug coverage, you may be eligible for a Special enrollment Period that will allow you to enroll in a Medicare Part D prescription drug plan without paying a penalty. 

WIth a SEP, you are required to enroll into a Medicare prescription drug plan within two months of your old plan ending. Coverage usually begins one month after signing up. 

You may also qualify for a SEP if you are moving outside of your current plan’s network.

If you tell your plan before you move, you are allowed to switch one more before your moving date or two months following the move. 

If you tell your plan after you move, you are allowed to switch anytime (within two months) without facing a penalty. It’s important to understand which potential penalties exist, in order to make sure you’re avoiding them.

Annual enrollment Period

Medicare offers an Annual enrollment Period that runs from October 15 to December 7 of each year. During this time, anyone is entitled to make changes to their existing Original Medicare plan. While this does include enrolling in a Medicare prescription drug plan, you may still be required to pay a late enrollment penalty. 

Medicare Advantage

Medicare Advantage combines the benefits of Original Medicare (Part A and B) with additional benefits like vision, dental, and usually prescription drug coverage. 

While Medicare Advantage isn’t offered directly through Medicare, all plans have been approved by the company and offer the same great coverage at a comparable cost to Original Medicare. 

If you would like a Medicare Advantage plan, you need to enroll through a private insurance company or broker. Plans and prices may vary slightly between companies and not all plans include prescription drug coverage, so it’s important to confirm what’s included during enrolment.

Final Thoughts and Additional Resources

In addition to prescription drug coverage under Medicare, you may also be interested in learning more about questions such as “Does Medicare cover dental?“, “How Long Before You Turn 65 do You Apply for Medicare?“, and finally information about how to apply for Medicare.

Our goal at MediClarity is to help make sense of the confusing world of Medicare and healthcare in general. It’s an ever-changing landscape, and it can be difficult to figure out on your own. We’re here to help you with the entire process, from the initial research to making your application, so ensure everything goes smoothly and that you don’t miss out on any important details. You don’t have to feel like you’re on your own while you navigate your health needs, and take proactive steps to protect your health and your finance right now and in the future, too.