Original Medicare does not cover prescription drugs, but as people age, there is a higher likelihood they need to take more prescriptions to maintain or improve their health. That’s why Medicare Part D was created—to ensure that seniors had affordable coverage for their prescriptions.
In this guide, we’ll cover when, why, and how to enroll in a standalone Part D plan to enhance Original Medicare coverage. Many Medicare beneficiaries choose to enroll in a Medicare Advantage plan to receive Part D coverage, and while there are similarities, they are different and can come with limitations. As such, we’ve covered Medicare Advantage enrollment in this article.
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Whether you want to switch from one plan to another or enroll in Medicare Part D for the first time, you are only able to do so during specific enrollment periods. Being aware of these enrollment periods is important because missing them can sometimes result in a late enrollment penalty and/or gaps in coverage. Below are short and sweet explanations of these enrollment periods to help you avoid late penalties.
When you initially sign up for Medicare, you’re also able to enroll in a Part D plan to receive prescription drug coverage. For most people, this period is the same as their Initial Enrollment Period, which is a 7-month window beginning three months before the month of your 65th birthday and extending until three months after your birth month. If you sign up for Medicare after you turn 65, however, then your Initial Coverage Election Period begins three months before your Part B coverage takes effect.
The Annual Enrollment Period occurs every year, between October 15 - December 7. During this period, Medicare beneficiaries are able to sign up for Part D plan for the first time, switch their Part D plan, or disenroll from a Part D plan and switch to a Medicare Advantage plan (with or without prescription drug coverage). During this time, you’ll likely receive several messages from Medicare professionals encouraging you to compare your coverage with the various plans available to you. Each year plans can change. Additionally, other plans and benefits may become available. This means it’s a good idea to confirm you’re on the best plan to fit your needs, but always be sure to check that you’re receiving the coverage you need.
If you are currently on a Medicare Advantage plan that you’re unhappy with, you can switch back to Original Medicare and a standalone Part D plan or to a different Medicare Advantage plan during the Medicare Advantage Open Enrollment Period, which lasts from January 1 - March 31.
In 2021, 48 million Medicare beneficiaries had Part D coverage, and about 50% of them were enrolled in a standalone Part D plan (vs. a Medicare Advantage plan with prescription drug coverage). As we age, we experience more medical issues that require prescriptions. Paying out of pocket for prescriptions is unmanageable for most, making prescription drug coverage critical for managing healthcare costs in retirement.
As far as whether to choose to cover prescriptions through a standalone Part D plan or through a Medicare Advantage plan, there are a lot of factors to consider, including varying coverage across plans and your current prescriptions.
In every zip code, there are an average of 54 Medicare plans with Part D coverage available to Medicare beneficiaries. This includes 23 standalone plans and 31 Medicare Advantage plans (the number of plans available varies based on zip code). Because there are so many prescription drug plans available, working with an advisor to sort through the available options is highly recommended.
Chapter provides free support and guidance to make choosing the best plan for you easy. We’ll help you compare available options and make sure your doctors, prescriptions, and services are covered.