When can I join, switch, or drop a Medicare drug plan?
- When you first become eligible for Medicare, you can join during your Initial Enrollment Period.
- If you get Part A and Part B for the first time during the General Enrollment Period, you can also join a Medicare drug plan from April 1– June 30. Your coverage will start on July 1.
- You can join, switch, or drop a Medicare drug plan during the Annual Enrollment Period between October 15– December 7 each year. Your changes will take effect on January 1 of the following year, as long as the plan receives your request before December 7.
- If you’re enrolled in a Medicare Advantage Plan, you can join, switch, or drop a MA-PD plan during the Medicare Advantage Open Enrollment Period, between January 1–March 31 each year.
- If you qualify for a Special Enrollment Period. Special Enrollment Periods are times when you can join, switch, or drop your Medicare drug coverage if you meet certain requirements. Generally, you must stay enrolled in your Medicare drug plan for the entire year, but you may be able to change your coverage mid-year if you qualify for a Special Enrollment Period when certain events happen in your life. Check with your plan carrier for more information.
- Read more about Important Dates here.
For Help Enrolling and Comparing existing Medicare Part D Plans in your service area, call us at the Medicare Comparison helpline (866-391-7763) to speak to a licensed agent who is specially trained to help you understand your prescription drug coverage options, or request assistance here: medicarecompareusa.com/speak-with-an-agent
Tips for Comparing Plans
It is most important to verify that your current medications are included in the plan’s Formulary before applying for coverage. Here are more tips when evaluating Part D Prescription Drug plans:
- Make a list of all your prescription drugs to including: the Name of the drug, the Dosage, and the Frequency of use. This information is necessary when comparing Part D Prescription plans. When making your list of medications don’t forget creams, ointments, eye drops, and nasal sprays that are prescribed by your physician.
- Review the formulary for your chosen Part D plan. If you do not see a specific name brand medication included, you will be required to purchase the medication on your own. Name brand medications can be very expensive, so be careful.
- Look at the different copayment “Tiers” featured by the plan. Remember that these copays are for a 30-day supply only, so you will need to multiply the copay by 12 in order to determine the annual out-of-pocket expense for a prescription.
- You should also confirm your preferred pharmacy is contracted with any Part D plans of interest.
- If you are taking a name brand medication and a generic equivalent is available, check with your physician to see if changing to the generic is advisable. If so, it can save you considerable money over the course of a year.
- If you are considering the benefits of joining a Medicare Advantage plan, keep in mind that many Medicare Advantage plans require you to join their Medicare Part D prescription drug plan (this applies to Medicare Advantage HMOs, PPOs, and Special Needs Plans). However, this requirement does not apply to Medicare Supplements, as you must purchase a Medicare Prescription plan separately.
- Not sure if your drugs are covered? The Medicare website’s plan finder (www.medicare.gov/drug-coverage-part-d/what-medicare-part-d-drug-plans-cover) has an extremely useful tool where you can enter your drug information and compare Medicare Prescription plans available in your area.
- Or you can always contact the Medicare Insurance Helpline and we’ll walk you through all of this: medicarecompareusa.com/speak-with-an-agent.
What’s the Part D late enrollment penalty?
The late enrollment penalty is an amount that’s permanently added to your Part D premium. You may owe a late enrollment penalty if at any time after your Initial Enrollment Period is over, there’s a period of 63 or more days in a row when you don’t have Part D or other creditable prescription drug coverage. You’ll generally have to pay the penalty for as long as you have Part D coverage. Note: If you get Extra Help, you don’t pay a late enrollment penalty.
3 ways to avoid paying a penalty:
- Join a Medicare drug plan when you’re first eligible. Even if you don’t take prescriptions now, you should consider joining a Medicare Prescription Drug Plan or a Medicare Advantage Plan that offers drug coverage to avoid a penalty. You may be able to find a plan that meets your needs with little to no monthly premiums.
- Enroll in a Medicare drug plan if you lose other creditable coverage. Creditable prescription drug coverage could include drug coverage from a current or former employer or union, TRICARE, Indian Health Service, the Department of Veterans Affairs, or individual health insurance coverage. Your plan must tell you each year if your drug coverage is creditable coverage. If you go 63 days or more in a row without a Medicare drug plan or other creditable prescription drug coverage, you may have to pay a penalty if you join later.
- Keep records showing when you had creditable drug coverage and tell your plan if they ask about it. If you don’t tell the plan about your creditable prescription drug coverage, you may have to pay a penalty for as long as you have Part D coverage.
How much more will I pay?
The cost of the late enrollment penalty depends on how long you didn’t have creditable prescription drug coverage. Currently, the late enrollment penalty is calculated by multiplying 1% of the “national base beneficiary premium” ($33.06 in 2021) by the number of full, uncovered months that you were eligible but didn’t join a Medicare drug plan and went without other creditable prescription drug coverage. The final amount is rounded to the nearest $.10 and added to your monthly premium. Since the “national base beneficiary premium” may increase each year, the penalty amount may also increase each year. After you join a Medicare drug plan, the plan will tell you if you owe a penalty and what your premium will be. For Example: If you are without creditable prescription drug coverage for 24 months, your penalty would be 24% (1% for each of the 24 months) of $33.06 (the national base beneficiary premium for 2020), which is $7.93. Rounded to the nearest $0.10, the late enrollment penalty will be $7.90 in addition to your plan’s monthly premium in 2021. You’ll continue to pay a penalty for as long as you have Part D coverage, and the amount may go up each year (read more here: www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/part-d-late-enrollment-penalty).