Prescription drugs are not covered by Original Medicare. You need to enroll in a stand-alone drug plan (Medicare Part D) if you want drug coverage. These plans are run by private companies not the Federal Government, although they do get “approved” annually by CMS. You have the option to choose from many companies in the area/county in which you reside. This is called your “service area.” If you ever move out of your service area, then you will have to look for another prescription drug plan in your new location.

You can sign up for Medicare Part D during:

• Your IEP (Initial Enrollment Period)
• When you are about to turn 65, you have a seven-month period in which you can enroll in Medicare Parts A and B. This includes three months before you turn 65, your birthday month and three months after your 65th birthday.

• The AEP (Annual Enrollment Period)
• From October 15^th to December 7^th each year. You can change your prescription drug plan during this time frame. However, it will not go into effect until January 1^st.
• If your birthday falls on the 1^st of the month, the your seven-month period would start the month before your birth month. Let’s say your birthday is on May 1^st. Then your IEP will be from January 1 to July 31.

• Special Enrollment Periods such as:
• Losing credible drug coverage
• Losing drug coverage from an employer or union
• You are eligible for Extra Help

Note: If you get Extra Help, or live in a nursing home, you may change your Part D plan once a month.

It is a good idea to sign up for Part D early to make sure your new plan begins when it should. If you do not sign up in a timely fashion, as indicated above, you will have to pay a late penalty, which may also delay the effective date of your Part D plan. This penalty is calculated at 1% of the “national base beneficiary premium” ($32.74 in 2020) multiplied by the number of months in which you were not covered.

Are there any requirements to be eligible for a Part D prescription drug plan?

In order to enroll in a drug plan, you are required to:

• Have Part A and/or Part B
• Reside in the service area of the plan, i.e. zip code or county

You can sign up for a Part D plan by:

• Calling Medicare at 1- 800-MEDICARE (800-633-4227); TTY: 877-486-2048;
• Call the plan of your choice or go to their online website and enroll directly.
• By using Medicare’s Plan Finder tool (see below)

If you take any medications, particularly if you take any that are expensive, it is very prudent that you use the Medicare.gov comparison tool (or have a broker do it for you) to compare the plans. The co-pays and lists of covered drugs can vary tremendously from company to company.

Here are the steps for using the plan finder tool:

• Go to medicare.gov/plan-compare – you can either create a login or continue without logging in. If you create a login, you will be able to see drug prices based on any help you get, compare plans, create and save your drug list, and other helpful features;

• Next you will be asked what type of drug plan you are looking for. Click on Drug Plan (Part D). You will then be asked to enter your zip code. If there is more than one county in your zip code, then it will bring up those counties and ask you to choose one.

• You will be asked if you get help from certain programs

• Do you want to see your drug costs?

• It will then ask how you pay for your drug costs: Retail pharmacy, mail order or both.

• If you have drugs to enter, you will be prompted to add those drugs. Once you are done adding drugs you will indicate your preferred pharmacy if that’s how you get your medications. A list of various pharmacies will come up in your zip code and neighboring ones.

• You will then see a list of plans which can be sorted by going to the dropdown box at the top right of the page. The choices are – a) lowest monthly premium; b) lowest yearly drug deductible; c) lowest drug + premium cost. Note: If you did not enter any drugs, then the last option will not be available.

• You can compare up to 3 plans at a time. You also can save and print the plan comparison(s).

As stated above, you may enroll directly on the plan-finder tool by clicking on the “enroll” button or by clicking on the plan to get the plan provider details.

How Do I Pay for My Part D Prescription Drug Plan?

The monthly premium will be deducted from your Social Security benefits every month in most cases. However, you also have the option to pay the plan directly via bank draft or have them bill you instead.

What Else Do You Need Besides Part D?

If you have Medicare Part A and Part B and you add Part D, you also have the option of getting a Medigap plan to fill in the gaps in Medicare A & B. Medigap plans pay the unlimited 20% that Medicare does not cover as well as, on some plans, covering the deductibles in Medicare. To compare the Medigap plans for your area, you can go here: Medigap quotes by email.

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65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. If you have any questions about this information, you can contact us online or call us at 877.506.3378.