When Do I Enroll In Medicare Part D

Is Part D A Requirement

Part D is a voluntary/optional part of Medicare it is not a requirement to have a Part D plan. You can certainly choose to not enroll in a Part D plan. If you dont have a Part D plan, you should understand that you would be responsible for any prescription medication costs that you incur. In addition to being responsible for all prescription costs, there are other implications that you should be aware of if you choose to not sign up for a Medicare Part D plan.

Medicare Part D Enrollment: Common Mistakes To Avoid

One major pitfall youll want to avoid with your Medicare prescription drug coverage is the late enrollment penalty. This penalty is an amount that is permanently added to your Medicare drug plans premium. You may have to pay this penalty if there is a period of 63 days or more after your Medicare IEP where you dont have creditable prescription drug coverage. Creditable drug coverage refers to a drug plan that pays at least as much as Medicare Part D on average.7

There are a few common mistakes that could land you with a :8

• Not enrolling in Medicare as soon as you can: Try to enroll in a Medicare or Medicare Advantage drug plan as soon as you qualify for Medicare. That way, you can avoid a late enrollment penalty later, even if you dont need prescription drugs right now.
• Not getting Medicare drug coverage if you lose other insurance: Once you go 63 days in a row without a Medicare drug plan or creditable drug coverage, you run the risk of getting a late enrollment penalty.
• Not keeping track of your records: If you get your prescription drugs with the help of creditable drug coverage, keep your plans records handy. If you dont tell your Medicare plan about this coverage, you may end up having to pay the late enrollment penalty.

When you enroll, its important to compare plans before you make a decision. Medicare Part D plans may differ based on their pharmacy networks, their premiums or the drugs they cover. Make sure you find a plan that works best for you.

Special Notice About The Medicare Part D Drug Program

Please read this notice carefully. It explains the options you have under Medicare prescription drug coverage and can help you decide whether or not you want to enroll in Medicare Part D.

Medicare prescription drug coverage became available in 2006 to everyone with Medicare through Medicare prescription drug plans and Medicare Advantage Plans that offer prescription drug coverage.

All approved Medicare prescription drug plans must offer a minimum standard level of coverage set by Medicare. Some plans may offer more coverage than required. As such, premiums for Medicare Part D plans vary, so you should research all plans carefully.

The State of Florida Department of Management Services has determined that the prescription drug coverage offered by the State Employees Health Insurance Program is, on average, expected to pay out as much as or more than the standard Medicare prescription drug coverage pays and is considered Creditable Coverage.

You can join a Medicare drug plan when you first become eligible for Medicare and each year from Oct. 15 to Dec. 7. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two-month Special Enrollment Period to join a Medicare drug plan.

Additional information about Medicare prescription drug plans is available from:

• MEDICARE or . TTY users should call 1-877-486-2048

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Medicare Enrollment When You Have A Disability Als Or Esrd

If you receive disability benefits from Social Security or the Railroad Retirement Board, you will automatically be enrolled in Medicare on the 25th month that you receive disability benefits. You will receive a Medicare card in the mail about three months before you are eligible.

If you have amyotrophic lateral sclerosis , you dont have to wait to be enrolled in Medicare. Youll get Medicare benefits in the first month that you receive disability benefits.

If you have End-Stage Renal Disease , you may be able to enroll in Medicare, but you will not be automatically enrolled. If you have ESRD, you are eligible for Medicare at any age if your kidneys no longer work, you need regular dialysis or have had a kidney transplant, and one of the following applies to you:

• Youve worked the required amount of time under Social Security, the Railroad Retirement Board, or as a government employee.
• Youre already getting or are eligible for Social Security or Railroad Retirement benefits.
• Youre the spouse or dependent child of a person who meets either of the two requirements above.

To enroll in Medicare if you have ESRD, contact Social Security. Individuals who enroll in Medicare due to ESRD will receive coverage beginning on the first day of the fourth month of dialysis treatments, regardless of when you sign up. Benefits can be applied retroactively if you wait until after your fourth month of dialysis treatments to enroll.

Signing Up For Medicare Part D

Signing up for Medicare Part D is simple. Once you enroll in Medicare Part A and Part B, you can enroll in Medicare Part D.

Like other parts of Medicare, unless you have creditable coverage, it is best to enroll during your initial enrollment period to avoid future penalties. To enroll, you must apply through Medicare and choose to enroll in any plan in your service area.

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Enroll By Mail Or Fax

Using our enrollment tool , enter your ZIP code and select the plan youre interested in. Once you’ve selected your plan, find the Enrollment Form for that plan under “Plan Documents.” Print and complete the form. Mail or fax your completed and signed forms to:

Cigna Medicare Prescription Drug PlanP.O. Box 269005

Medicare beneficiaries may also enroll in Cigna Medicare Plans through the Centers for Medicare & Medicaid Medicare Online Enrollment Center .

Already Enrolled In Medicare

If you have Medicare, you can get information and services online. Find out how to .

If you are enrolled in Medicare Part A and you want to sign up for Part B, please complete form CMS-40B, Application for Enrollment in Medicare Part B . If you are applying for Medicare Part B due to a loss of employment or group health coverage, you will also need to complete form CMS-L564, Request for Employment Information.

You can use one of the following options to submit your enrollment request under the Special Enrollment Period:

Note: When completing the forms CMS-40B and CMS-L564:

• State I want Part B coverage to begin in the remarks section of the CMS-40B form or online application.
• If possible, your employer should complete Section B.
• If your employer is unable to complete Section B, please complete that portion as best as you can on their behalf and submit one of the following forms of secondary evidence:
• Income tax form that shows health insurance premiums paid.
• W-2s reflecting pre-tax medical contributions.
• Pay stubs that reflect health insurance premium deductions.
• Health insurance cards with a policy effective date.
• Explanations of benefits paid by the GHP or LGHP.
• Statements or receipts that reflect payment of health insurance premiums.

Some people with limited resources and income may also be able to get .

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Medicare Prescription Drug Plan Availability In 2022

In 2022, 766 PDPs will be offered across the 34 PDP regions nationwide , a substantial reduction of 230 PDPs from 2021 and the first drop in PDP availability since 2017 .

The relatively large decrease in the number of PDPs for 2022 is primarily the result of consolidations of plan offerings sponsored by Cigna and WellCare resulting in the market exit of three national PDPs from each firm in each region. This accounts for just over 200 PDPs offered in 2021 that will no longer be offered in 2022. Enrollees in these non-renewing plans will be automatically switched to other plans offered by the same plan sponsors, although they can choose to switch into a different plan.

Despite the reduction in PDP availability for 2022, beneficiaries in each state will have a choice of multiple stand-alone PDPs, ranging from 19 PDPs in New York to 27 PDPs in Arizona . In addition, beneficiaries will be able to choose from among multiple MA-PDs offered at the local level for coverage of their Medicare benefits.

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Recent Articles And Updates

For older articles, please see our article archive.

References

The 2010 Medicare Part D $250 Donut Hole Rebate. Q1Group LLC, .

2020 Part D Income-Related Monthly Premium Adjustment. . .

2021 Medicare Part D Outlook.Q1Group LLC, .

2021 Part D Income-Related Monthly Premium Adjustment. . .

How Do Medicare Advantage Ppo Plans Work? Healthline Media, May 5, 2021, .

Analysis of Part D Beneficiary Access to Preferred Cost Sharing Pharmacies . . .

Announcement of Calendar Year 2021 Medicare Advantage Capitation Rates and Part C and Part D Payment Policies. . .

Assistance with Paying for Prescription Drugs. Center for Medicare Advocacy, November 30, 2015, .

How Medicare Part D Works. AARP, October 2016, .

Medicare Advantage Special Needs Plans . Healthline Media, May 3, 2021, .

Kirchhoff, Suzanne M. Medicare Coverage of End-Stage Renal Disease . . .

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When You Can Switch Part D Plans

In general, you may only switch plans during the Annual Election Period . This is between October 15 and December 7 each year. Coverage begins the following January 1. Outside of the AEP, you may change plans if you have a Special Election Period , such as if you:

• Move to another region outside the service areas of your plan
• Enter a nursing home
• Change nursing homes or other institutions
• Qualify for the extra help/Low-Income Subsidy program
• Lose your eligibility for extra help/LIS
• Lose your full Medi-Cal benefits

Medicare Part D Prescription Drug Plans: What You Need To Know

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Big changes are coming to Medicare Part D prescription drug coverage following the passage of the Inflation Reduction Act of 2022, which gives Medicare the power to negotiate for lower prescription drug prices. The act also includes caps on out-of-pocket spending, limits on increases in Medicare Part D premiums and drug prices, and more.

Certain changes will take effect in 2023, while others start as late as 2026.

» Read more:What the Inflation Reduction Act means for your Medicare coverage

Medicare Part D covers prescription drugs and is offered by private insurers approved by the federal government. Most recipients pay a monthly premium that varies by plan based on your state, county and ZIP code, plus copays and other potential costs. Introduced in 2006, Part D is Medicares most recent addition. While Part D is technically optional, there are steep and permanent penalties if you don’t sign up on time.

If you choose Medicare Advantage , most of those plans include prescription drug coverage. If yours doesnt, it’s unlikely you’ll be able to add a separate, stand-alone Part D plan.

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General Enrollment/medicare Advantage Open Enrollment

From January 1 to March 31, you can change or drop Medicare Advantage plans with Part D coverage or join original Medicare during this time.

You cant join a Part D plan during this time if you have original Medicare.

If you have questions about your Medicare part D coverage or enrollment periods, reach out to the insurance company from whom you purchase your coverage, contact the State Health Insurance Assistance Programs National Network or call 800-MEDICARE.

How Much Is The Part D Penalty

The cost of the late enrollment penalty depends on how long you went without Part D or creditable prescription drug coverage.

Medicare calculates the penalty by multiplying 1% of the “national base beneficiary premium” times the number of full, uncovered months you didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.

The national base beneficiary premium may change each year, so your penalty amount may also change each year.

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Why You Should Review Your Medicare Plan Each Year

Although most Medicare plans renew automatically, your needs may change from year to year. Each fall, make time to sit down and review all of your Medicare plans. This will give you a chance to make changes if necessary and be confident that all of your needs will be met in the coming year.

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Key Things To Know About Medicare Part D

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Why Should I Enroll In A Medicare Part D Prescription Plan When I Am Not Taking Any Prescriptions

The short answer is that you will not face the late enrollment penalty. Keep in mind that the late enrollment penalty percentage will follow you each year no matter which plan you are enrolled in. The next reason why you should at least be enrolled in the cheapest premium plan is that you never know when your doctor may have to prescribe a prescription and you want to have coverage to help pay for it. In reality, we never know what kind of prescription we might need or how expensive it will be.

When To Enroll In Medicare Part D

Enrolling in a Medicare Part D plan is much different than enrolling in Original Medicare, because these plans are sold by private insurance companies and not provided by the government. You must first be enrolled in Medicare Part A and Part B. Then, you have the option of applying for a plan for the first time during one of these three enrollment periods:

• You 7-month Medicare Initial Enrollment Period starting 3 months before you turn 65
• Medicare Annual Enrollment Period between October 15 December 7
• A Medicare-approved Special Enrollment Period

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What Are The Circumstances That May Require Me To Renew Medicare Coverage

So long as you pay your monthly premium and continue to collect Social Security, you will never need to renew your Original Medicare plan. Parts A and B are provided by the federal government and are not subject to the changes that may affect private insurers.

Conversely, Medicare Advantage and Medicare Part D are offered by private insurers and therefore come with the same caveats youd expect from any insurance plan.

The most common reason for needing to re-enroll in your plan is if your plan becomes unavailable in your area. This is most commonly due to a move but can also occur if a plan changes its service area. An insurance company might also decide to stop offering a specific plan. Finally, the government might stop offering a Medicare Advantage or Medicare Part D plan due to a low star ranking.

Regardless of the reason, plan members affected by these changes are typically eligible for a Special Enrollment Period, allowing them to sign up for a different plan outside of typical enrollment periods.

What If Im Not Automatically Enrolled At 65

If your Medicare enrollment at 65 is not automatic, but you want to enroll, here are some more magic numbers.

3 and 7.

To start taking advantage of Medicare at 65, you need to sign up during the three months before the birthday month you turn 65. Those are the first three months of your seven-month Initial Enrollment Period.

Unless your birthday is on the first day of the month, your Initial Enrollment Period includes the three full months before turning 65, the month you turn 65, and the three months after you turn 65. If you were born on the first day of the month, IEP is the four months before your birth month, along with your birthday month and the two months after.

If you sign up during one of the months before your 65th birthday, your coverage will begin on the first day of the month you turn 65 .

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