Skip to main content

Medicare Part D - Frequently Asked Questions

Who Can Get Medicare Part D Drug Coverage?

Everyone with Medicare can get prescription drug coverage. This includes people who are 65 years or older and who are U.S. citizens or permanent residents, and people under 65 with certain disabilities, including End-Stage Renal Disease (ESRD) and amyotrophic lateral sclerosis (Lou Gehrig's Disease).

How Do Medicare Drug Plans Work?

After you join a Medicare drug plan, the plan provider will mail you membership materials, including a card to use when you get your prescriptions filled. When you use the card, you may have to pay a copayment, coinsurance, and/or deductible if any are charged by the plan.

Choosing Medicare Prescription Drug Coverage

Joining a Medicare drug plan when you are first eligible means you won't have to pay a late-enrollment penalty.

From October 15 to December 7 you may switch to a different Medicare drug plan if your plan coverage changes or your needs change. When you join or switch to a new Medicare drug plan, your coverage will generally begin on January 1 of the following year.

How Much Does Medicare Drug Coverage Cost?

Your costs will vary depending on the drugs you use, the plan you choose, and whether you qualify for extra help paying your Medicare Part D costs. Exact coverage and costs are different for each plan, but all Medicare drug plans must provide at least a standard level of coverage set by Medicare. Call the plan you're interested in to find out more about plan costs.

Payments you make in a Medicare drug plan include the following:

When Can You Join, Switch, or Drop a Medicare Drug Plan?

You can join, switch, or drop a Medicare Part D Drug Plan at these times:

How Do You Switch Your Medicare Drug Plan?

You may change your Medicare Depending on your circumstances, you can switch to a new Medicare drug plan by simply joining another drug plan during one of the times listed above. You don't need to tell your old Medicare drug plan you are leaving or send them anything. You will be disenrolled automatically from your old Medicare drug plan when coverage in your new drug plan begins. You should get a letter and enrollment information from your new plan provider in the mail. Don't give personal information to plans that call you unless you're already a member of the plan.

How Do You Join a Medicare Drug Plan?

According to Medicare, once you choose a Medicare drug plan, here's how you may be able to join:

When you join a Medicare drug plan, you'll give your Medicare number and the date your Part A and/or Part B coverage started. This information is on your Medicare card.

What Is the Medicare Part D Late-Enrollment Penalty?

If you don't join a Medicare drug plan when you are first eligible for Medicare Part A and/or B and you go without creditable prescription drug coverage for 63 continuous days or more, you may have to pay a late-enrollment penalty to join a plan later. This penalty amount changes every year, and you will have to pay it as long as you have Medicare prescription drug coverage.

How Much Will Your Part D Late-Enrollment Penalty Be?

Your late-enrollment penalty is calculated when you join a Medicare drug plan.

To estimate your penalty amount, multiply 1% of the national base beneficiary premium for the current year ($31.17 x 1% = $0.31 in 2013) by the number of full months you were eligible to join a Medicare drug plan but didn't. Round this to the nearest ten cents. This penalty amount is added each month to your Medicare drug plan's premium for as long as you have a plan.

For example, if you waited 24 months to join a plan, you would multiply $0.31 times 24 for a total penalty, after rounding, of $7.44. This amount would be permanently added to the monthly premium of the plan you chose. The national base beneficiary premium may increase each year, so the penalty amount may also increase each year.

What If You Have Full Coverage from Your State Medicaid Program and Are Eligible for Medicare?

What If You Get Certain Benefits or Other Help to Pay Prescription Costs, and Medicare Automatically Enrolls You in a Plan?

If you have other prescription drug coverage that's at least as good as Medicare's drug coverage (creditable prescription drug coverage), you may not want to keep the drug plan Medicare enrolls you in. If you don't want to keep this plan, or to have Medicare enroll you in another drug plan, call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week, or the plan provider. TTY users should call 1-877-486-2048. Tell them you want to disenroll from this plan (or opt-out of "automatic" or "facilitated" enrollment).

What If You Get Prescription Drug Coverage from TRICARE, the Department of Veterans Affairs (VA), or the Federal Employee Health Benefits Program (FEHBP)?

What if You Get Prescription Drug Coverage from the Indian Health Service, Tribe or Tribal Health Organization, or Urban Indian Health Program?

What If You (or Your Spouse) Have Prescription Drug Coverage from a Former or Current Employer or Union?

We strongly recommend that you speak to your current benefits administrator to see what the impact of Medicare Part D enrollment will be on your current coverage.

In some cases, joining a Medicare drug plan might cause you, or your spouse, or other dependents to lose some or all of your employer or union coverage.

In other cases, if you join a Medicare drug plan and you also have employer or union coverage, you may still be able to use your employer or union coverage along with the plan you join.

Employers and unions that provide prescription drug coverage must notify you each year about how your current coverage compares to Medicare's basic prescription drug coverage.

You may get this information in a letter, in a notice from your plan, or in your benefits handbook. Use this information to help you decide whether to join a Medicare drug plan.

Keep the notices you get. You may need to show them as proof of creditable prescription drug coverage if you join a Medicare drug plan later. If you don't get this information, contact your benefits administrator.

If your employer or union stops offering prescription drug coverage that is creditable, you won't have to pay a late-enrollment penalty if you join a Medicare drug plan and your coverage begins before you go 63 days without coverage.

If your employer or union drug coverage isn't as good as Medicare prescription drug coverage (not creditable), talk to your benefits administrator to learn about your choices.

Call your benefits administrator before you make any changes.

For further information please visit the official Medicare Part D Website or call Medicare Helpline at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week (TTY users, call: 1-877-486-2048).