En español | You can get Medicare prescription drug coverage (Part D) in one of two ways: through a “stand-alone” Part D drug plan (which provides only prescription drugs and is used by people enrolled in the original Medicare program) or through a Medicare Advantage managed care plan (such as an HMO or PPO) which includes Part D drug coverage in its benefits package. Both types of plan are offered by private insurance companies that are regulated by Medicare.
Whether you choose a stand-alone Part D drug plan or a Medicare Advantage plan, you must enroll during a designated enrollment period:
- Your initial enrollment period (IEP), which runs for seven months, of which the fourth is the month of your 65th birthday.
- A special enrollment period (SEP), which you’re entitled to in certain circumstances:
• If you qualify for Extra Help (which provides low-cost Part D coverage to people with limited incomes) or enter or leave a nursing home, you can join a Part D drug plan or switch to another at any time of the year.
• If you lose creditable drug coverage from elsewhere — such as an employer, union, retiree benefits, COBRA, Medicaid, or the Veterans Affairs health care program — you can sign up with a drug plan within two months of this coverage ending.
• If you move outside of your current drug plan’s service area (which means to another state if you’re enrolled in a stand-alone Part D plan), you can sign up with a new plan, either before or within two months of the move.
• If your current Part D plan withdraws service from your area, you can switch to another plan before or when your current coverage ends.
• If you return to the United States after living abroad, or are released from prison, you can sign up with a Part D drug plan within two months of your return or your release.
• If you want to switch to a Part D plan or a Medicare Advantage plan that has earned Medicare’s highest quality rating (five stars) and is available in your area, you can do so at any time of the year except for the first week of December .
• If a plan violates its contract with you, you can ask Medicare to investigate; if Medicare agrees, you can switch to another plan at that time.
• If a federal employee made a mistake when processing your enrollment or disenrollment in a plan, you get a two-month SEP to switch to another plan if Medicare approves your claim.
- The annual open enrollment period (Oct. 15 to Dec. 7 each year) when you can join a drug plan for the first time if you missed your deadlines for your IEP or a SEP, or switch from original Medicare to a Medicare Advantage plan, or switch from one Medicare Advantage plan to another, or switch from one Part D drug plan to another.
- The annual “disenrollment” period (Jan. 1 to Feb. 14) when you can opt out of a Medicare Advantage plan (regardless of how long or short a time you’ve been enrolled) and return to the original Medicare program. During this period you can also join a stand-alone Part D drug plan, provided that you had been receiving drug coverage from the Medicare Advantage plan.
- A general enrollment period (Jan. 1 to March 31 each year), if you missed your deadline for signing up for Medicare (Part A and/or Part B) during your IEP or an SEP. In this situation Medicare coverage will not begin until July 1 of the same year in which you enroll. You can sign up for a Part D drug plan or a Medicare Advantage plan between April 1 and June 30 to begin receiving drug coverage under it on July 1.
Note that you cannot get Part D drug coverage outside of these specified enrollment periods. At other times, you cannot just sign up when you need medications, no matter how urgently your medical condition requires them.
If you fail to sign up during one of these time frames, you face two consequences. You will be able to enroll in a Part D plan only during open enrollment, which runs from Oct. 15 to Dec. 7, with coverage beginning Jan. 1. And you will be liable for late penalties, based on how many months you were without Part D or alternative creditable coverage since turning 65, which will be added to your Part D drug premiums for all future years.
