Section 5: ready to enroll
How to Enroll in a Part D Plan
If you don’t have adequate prescription drug coverage, you’ll need to pick a plan
ESTIMATED READ TIME: 4 MINUTES
IN THIS ARTICLE
• 8 steps to sign up for a Part D prescription drug plan
• How to pay for Part D
• Who pays the high-income surcharge?
If you’ve opted for original Medicare, you may need a Part D prescription drug plan. Most Medicare Advantage plans cover prescriptions. You can also enroll in a stand-alone Part D plan.
If you have drug coverage, find out if it’s as good or better than a basic Part D plan, what’s known as creditable coverage. Every September your health plan should send you a notice telling you whether your current coverage is considered creditable.
If you have creditable coverage, you don't need to sign up for Part D. If you don’t, you’ll need to find a plan or face a late enrollment penalty that will be added to your Part D premium every month.
If you don’t have creditable prescription drug coverage, the best time to sign up for a Part D plan is during the seven-month initial enrollment period surrounding your 65th birthday — even if you don’t take any daily prescriptions now. If you decide to enroll in an economical plan to avoid penalties, you can change your coverage during Medicare’s annual open enrollment period from Oct. 15 to Dec. 7. Coverage starts Jan. 1.
8 STEPS TO SIGN UP FOR A PART D PRESCRIPTION DRUG PLAN
1. Compare the Part D options in your area by using the Plan Finder tool at Medicare.gov.
2. You can either log into your online Medicare account or you can go to the "Continue without logging in" box where you can enter your zip code and select your county. Then choose “Drug plan (Part D)” from the plan type dropdown menu.
3. Now indicate whether you get help with your medical expenses. If you’re not sure, you can find out by logging in to your Medicare account.
4. If you don’t receive any help, you’ll be asked if you want to see your drug costs when you compare plans. Click "Yes" so you can get a sense of how much you would spend with each plan.
5. Enter the names of your medications. Be sure to include ones you take regularly so that you’ll get a good estimate of ongoing costs. You’ll also need to select the dosage and quantity and indicate how frequently you need to refill your prescriptions. To add another medication, click "Add Another Drug." When you’re finished, click "Done Adding Drugs."
6. Choose up to five pharmacies where you want to fill your prescriptions. Many plans charge lower copayments for preferred pharmacies. You can see how plans work with the pharmacies and what your copayments would be for each one. Enter the names of the pharmacies you use or search by your address or zip code.
Every plan with drug coverage offers mail-order prescriptions. They can be less expensive, so some people select this option as one of their pharmacy choices. When you’re finished selecting pharmacies, click "Done."
7. You’ll receive a list of drug plans in your area. You can sort the plans in three ways: "Lowest drug + premium cost," the default; "Lowest yearly drug deductible;" and "Lowest monthly premium." The best way to compare plans is to look at each plan’s lowest drug and premium costs.
Keep in mind: A plan with a low premium could be more expensive by the end of the year if it charges high copayments for your medications. Click the "Plan Details" button for more information, including a monthly estimate of what you’ll pay for your medications.
If you're interested in a plan, before signing up, be sure to check whether your prescriptions are part of a plan’s formulary — the list of regularly covered drugs. Some expensive medicines require prior authorization from the plan before you can purchase them.
8. To sign up for a Part D plan, click "Enroll." You’ll need your Medicare number and the date that your Parts A and B coverage started. You may be able to enroll with an insurance agent or by calling 800-MEDICARE (800-633-4227).
To sign up directly with the insurance company, click "Plan Details" and look for the plan’s phone number and website. You can also request an application and mail it. An insurance agent may be able to help you enroll.
For help signing up for a Part D plan, contact your State Health Insurance Assistance Program (SHIP).
HOW TO PAY FOR PART D
After you’ve signed up, you’ll pay monthly Part D premiums to the insurance company. You may either receive bills or sign up for automatic payments. You also may be able to request that your premium be deducted from your monthly Social Security or Railroad Retirement Board payment.
To find out if you qualify for financial assistance for Part D, see How to Get Help Paying for Medicare.
WHO PAYS THE HIGH-INCOME SURCHARGE?
If your adjusted gross income is more than $97,000 if you’re single, or $194,000 if you’re married and filing jointly, you may have to pay a high-income surcharge, which adds $12.20 to $76.40 to your monthly premiums in 2023
The high-income surcharge is paid to Medicare. These premiums can be deducted automatically from your Social Security benefits or Medicare can send you a bill. Another option is to sign up for Easy Pay and have the premiums automatically paid from your checking or savings account.
Mark your calendar for Medicare’s annual open enrollment period from Oct. 15 to Dec. 7. This is the time you can switch Part D plans.
Even if you’re satisfied with your coverage, it’s a good idea to go to Medicare.gov to compare the plans available in your area. Plans can change their coverage, costs and provider networks every year.
Updated February 14, 2023
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