Medicare Part D is prescription drug coverage you add to Original Medicare

Medicare Part D is optional coverage that pays for prescription medications. You enroll through insurance companies approved by Medicare, not through Medicare directly. The enrollment window is usually October 15 through December 7 each year, though you may be able to join outside that window if you meet certain conditions.

Part D plans vary in cost, deductible, and which drugs they cover. You pick the plan that matches your medications and budget. If you don't join when you first become Medicare-may be able to access and you go without creditable drug coverage for 63 days or more, you'll pay a permanent penalty on top of your premiums.

Key Takeaways

  • You enroll in Part D through private insurance companies, using Medicare's Plan Finder tool at Medicare.gov to compare plans in your area.
  • The standard enrollment period runs October 15 through December 7 each year, with coverage starting January 1.
  • You need to know your current medications and their dosages before comparing plans, because coverage and costs differ by drug and plan.
  • If you miss the enrollment window and don't have other creditable drug coverage, you'll pay a late penalty for as long as you have Part D.
  • You can change plans once per year during the annual enrollment period, or switch to a different plan type if your circumstances change.

Using Medicare's Plan Finder to compare Part D options

Go to Medicare.gov and select "Find Care Providers & Suppliers" or search for "Plan Finder." You'll enter your ZIP code, the medications you take (including dosage and frequency), and your pharmacy. The tool shows all Part D plans available in your area, ranked by estimated yearly cost.

The Plan Finder estimates what you'll pay out of pocket for your specific drugs under each plan. This includes the monthly premium, any deductible, and your share of the drug cost. Plans with lower premiums sometimes have higher deductibles or higher copays per drug, so compare the total yearly cost, not just the monthly premium.

You can save your results and come back to them later. Many people compare plans over several days before deciding. The tool updates each October when the new plan year's information becomes available.

Enrolling through an insurance company or Medicare

Once you've chosen a plan, you can enroll directly through the insurance company's website, by phone, or by mail. You can also enroll through Medicare.gov by clicking the plan name in your Plan Finder results.

When you enroll, you'll need your Medicare number (on your red, white, and blue Medicare card) and basic personal information. The insurance company will confirm your enrollment and send you a member card in the mail, usually within two weeks.

If you enroll between October 15 and December 7, your coverage starts January 1. If you enroll outside the standard period (because you may have access to for a special enrollment period), your coverage start date depends on when you enroll.

What to do if you miss the October through December window

If you don't join a Part D plan during the standard enrollment period, you can still join if you have a may have access to life event. These include losing employer coverage, moving to a new state, or becoming newly may be able to access for Medicare. You have 63 days from the event to join without penalty.

If you don't join during the standard period and don't have a may have access to event, you'll have to wait until the next October 15 to enroll. In the meantime, you'll owe a late penalty that increases the longer you go without coverage. The penalty is roughly 1% of the national average Part D premium for each month you're not covered, and it stays on your premium permanently.

The exception is if you have creditable coverage — drug coverage through an employer, union, or Veterans Affairs that's at least as good as Part D. If you have creditable coverage, you won't pay a penalty when you eventually join Part D, as long as you can show proof of that coverage.

Costs you'll pay under a Part D plan

Part D costs include a monthly premium (which varies by plan), an annual deductible (which can range from zero to several hundred dollars), and your share of the drug cost once you've met the deductible. Your share is usually a copay (a flat dollar amount per prescription) or coinsurance (a percentage of the drug's cost).

Most plans have a coverage gap, sometimes called the "donut hole." Once you and your plan have spent a certain amount on drugs in a year, you enter the gap and pay a higher share of the cost until you reach a yearly out-of-pocket limit. After that, the plan covers most of your drug costs for the rest of the year.

The exact costs depend on the plan you choose and the drugs you take. The Plan Finder shows your estimated costs for your specific medications under each plan, so you can see the real numbers before you enroll.

Changing your plan if your needs change

You can switch to a different Part D plan once per year during the annual enrollment period (October 15 through December 7). Your new coverage starts January 1. You can also switch plans if you have a may have access to life event, such as moving, losing coverage, or a major change in your medications or health.

If you're unhappy with your plan during the year, contact the insurance company to ask about your options. Some plans allow you to request an exception to cover a drug that's not normally on their formulary, or to waive a prior authorization requirement. These requests can sometimes be approved without waiting until the next enrollment period.

Keeping your coverage active each year

Your Part D plan renews automatically each January 1 unless you actively switch to a different plan. However, plans change their premiums, deductibles, and drug formularies each year. It's a good idea to review your coverage each October during the enrollment period, even if you plan to stay with the same plan.

If your plan is no longer available or if your medications are no longer covered, you'll receive a notice from your insurance company. You can then choose a new plan during the enrollment period. If you don't choose a new plan and your current plan is discontinued, Medicare will automatically enroll you in a similar plan in your area.

Frequently Asked Questions

Do I have to join Part D when I turn 65?

No, Part D is optional. However, if you don't join when you first become Medicare-may be able to access and you don't have other creditable drug coverage, you'll pay a permanent late penalty once you do join. If you rarely take medications, you may decide the penalty is worth avoiding the premium cost, but this is a decision to make carefully with your doctor.

Can I use my current pharmacy with a Part D plan?

Most Part D plans work with many pharmacies, but not all. When you're comparing plans in the Plan Finder, enter your pharmacy to see which plans include it in their network. If your pharmacy isn't in a plan's network, you can ask the pharmacy if they'll accept that plan, or you can choose a different plan that includes your pharmacy.

What if my doctor prescribes a drug that my Part D plan doesn't cover?

You can ask your doctor to prescribe a different drug that is on your plan's formulary, or you can request a formulary exception. To request an exception, contact your Part D plan and ask them to review whether they'll cover the drug. Your doctor may need to provide information about why this specific drug is medically necessary. The plan has 72 hours to respond to your request.

Can I switch Part D plans in the middle of the year?

You can switch plans during the annual enrollment period (October 15 through December 7) or if you have a may have access to life event, such as moving, losing coverage, or becoming newly may be able to access for Medicaid. Outside these windows, you're locked into your current plan until the next enrollment period.

What happens to my Part D coverage if I move to a different state?

Your current plan may not be available in your new state. When you move, you have 63 days to join a new Part D plan in your new state without penalty. Use the Plan Finder and enter your new ZIP code to see which plans are available where you're moving. Contact your current plan to let them know you're moving, and they can help you understand your options.