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When can I enroll in Medicare Part D?

Just the essentials...

  • You can choose to enroll in Medicare health plans around your 65th birthday, or during the annual enrollment period.

  • If you qualify, sign up for Medicare Part D during your initial enrollment period (IEP) to avoid any late penalty.

  • You can switch from Medicare Advantage to Medicare Part D during the Medicare Advantage Disenrollment Period between January 1 and March 31 each year.

When can I enroll in Medicare Part D?

When you enroll in Medicare, you can choose a Medicare Part D policy, or a Medicare Advantage (Part C) plan that builds in prescription coverage.

Typically, people enroll in either C or D at the same time as Medicare A and B.

While unnecessary to apply for Medicare every year, you do get the chance to review your choices every year.

However, only a small window of time each year allows plan changes.

Medicare has several different programs available to enrollees.

Ideally, the time to get Medicare Part D coverage is the same seven month initial enrollment period used for Parts A and B. The seven-month period begins three months before a person’s 65th birthday.

Enter your zip above to start comparing private Medicare Advantage and other supplemental coverage options in your state.

What happens if you don’t enroll in Medicare Part D during your initial enrollment period?

When can I enroll in Medicare Part D? - Medicare Enrollment Form

If you fail to enroll in Medicare Part D during your initial enrollment period, you won’t have another opportunity until the open enrollment period begins.

Open enrollment starts in the fall of each year, running from October 15th to December 7th.

Any changes made to Part D coverage during this time become effective January 1st of the following year.

Not only does enrolling during this period of time give you access to coverage, it would also stop any more build up of late penalty fees, if any.

The fee amount relates to how long you went without prescription drug coverage while you were Medicare eligible.

Part D Penalties

To be brief, if you sign up after your seven month IEP, you may have to pay a penalty.

The Part D late enrollment penalty kicks in after 63 days in a row of lacking Medicare prescription coverage, or a standard equivalent.

In the majority of cases, the Part D penalty adds 1% of the national average cost of a Part D premium. Then, it multiplies by the number of months gone without prescription coverage.

As of 2021, the national average of $33.06 means that a 1% penalty amounts to about $0.30 rounded.

While small at first, if compounded over years or decades this penalty can result in heavy cost. That expense may come at the time you need prescription coverage most.

On the other hand, the penalty can be waived in some cases.

Some begin Medicare prior to age 65 due to disability and also pay a late penalty due to delayed sign up for Medicare Part D at the time. Surrounding their 65th birthday, that penalty fee is eliminated. This is because a new Initial Enrollment Period (IEP) will have started.

 

Special Enrollment Periods and Who Can Apply

When can I enroll in Medicare Part D?

Some individuals may qualify for a special enrollment period.

During this type of enrollment timeframe, individuals can apply for Medicare Part D coverage; despite their IEP and without any penalties associated with the cost.

In order to qualify for a special enrollment period, you must have had an opportunity to enroll, but exceptional circumstances may have caused you to become delayed.

Below are several examples of situations that qualify an individual for special enrollment privileges:

  • Lost employer drug coverage
  • Qualified for Extra Help or state Medicaid
  • Affected by FEMA-declared natural disaster
  • Moved, or planning to move to a new area
  • Your current Medicare health plan is no longer offered

From case to case, the time granted for a special enrollment period may widely vary.

What is Extra Help and who gets it?

Extra Help is a federally-funded government Social Security Program. The term Low Income Subsidy (LIS) more officially refers to this program.

The program, offered to low-income Medicare enrollees, helps specifically with the cost of prescription drugs and monthly premiums for drug coverage.

Many people qualify for these savings, and don’t even know it.

To qualify for Extra Help, a person or married couple must have Medicare while living on limited income or resources.

Overall, the program helps Medicare enrollees pay for associated Part D costs including:

  • Prescription plan Deductibles
  • Drug Copays
  • Prescription plan premiums
  • Part D late enrollment penalties

When does Medicare Part D coverage begin?

Sign-up for Medicare Parts A, B, and C or D in the three months before you turn 65 allows coverage to begin as soon as possible.

If you sign up for either the Part D or Medicare Advantage program during that time, your coverage will start as soon as you become eligible for Medicare.

Usually, Medicare coverage begins on the first day of the month of your 65th birthday.

If you wait until the month you are eligible for coverage, or up to 3 months after your 65th birthday, the benefits will begin on the first day of the month following your enrollment.

How do you switch to Medicare D from Medicare Advantage?

When can I enroll in Medicare Part D?

If you opted for Medicare Advantage rather than Original Medicare and wanted to make a switch, you can do so at a specific time of year.

Every year, a Medicare Advantage Disenrollment Period takes place.

From January 1 until March 31 enrollees can drop their Medicare Advantage plan, returning to Original Medicare. During this time, beneficiaries can join a Medicare prescription drug plan after dropping a Medicare Advantage plan.

At that point, an enrollee will use their Part D plan to obtain prescription drugs rather than their Advantage plan.

Enrollees should choose a Medicare Part D immediately when they switch from Medicare Advantage back to Original Medicare.

If no coverage is selected at that time, the beneficiary will have to wait until the next enrollment period to choose prescription coverage. During this period, the enrollee will not have prescription drug coverage and therefore may build up a late penalty.

Unless they have another plan, such as an employer’s insurance, responsibility for drug cost becomes entirely out of pocket.

Prescription drugs can be expensive. Many individuals count on medications to keep them well throughout the year, or to manage symptoms. Without prescription coverage, many patients cannot afford their prescriptions.

Medicare enrollees should keep either a Medicare Part D plan, or a Medicare Advantage plan that includes Part D. Importantly so, to avoid missing access to affordable drug coverage, and to avoid paying more for drug coverage later.

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