Prescription Drug Plans

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What is Medicare Part D?

Medicare Part D is prescription drug coverage offered by private insurers and regulated by Medicare. You should enroll in a Part D plan when you first become eligible for Medicare if you have:


  • Original Medicare Part A (hospital) and/or Part B (medical)

  • A Medicare Advantage (Part C) plan that doesn’t include drug coverage

Important Note: Part D plans are not legally required, but unless you have other creditable drug coverage, it’s financially risky to skip Part D. Even if you don’t take many prescriptions now, it’s smart to enroll in a low-cost plan when you become eligible to avoid lifetime penalties and limited access.

Choosing a Prescription Drug Plan

Selecting the right Part D plan involves these key factors:


  • Costs: Compare plans’ monthly premiums, annual deductibles, and coinsurance.

  • Drug Coverage (Formulary): Review each plan's list of covered drugs, which are generally organized into tiers that will determine your out-of-pocket cost. Make sure your medications are covered at a level you can afford, and check for any restrictions like prior authorization or quantity limits.

  • Pharmacy Network: Verify that the pharmacies you use are included in the plan’s network. Some plans offer discounts if you use their preferred pharmacies or mail-order platforms.

Note: Medicare’s rules for out-of-pocket limits and drug tiers are updated annually, so check with us to make sure you have the latest information.

Enrolling in Part D Plans

There are a few times throughout the year when you can enroll in Medicare Part D coverage:


  • Annual Enrollment Period (AEP): October 15 to December 7 every year; change, switch, or leave Part D plans. It is crucial to review and adjust coverage every year based on changing needs and formularies.

  • Initial Enrollment Period (IEP): The seven-month window when you first become eligible for Medicare (starts three months before your 65th birthday month and ends three months after).

  • Medicare Advantage Open Enrollment (OEP): January 1 to March 31 every year; switch Advantage plans or return to Original Medicare and join a standalone Part D plan.

  • Special Enrollment Periods (SEPs): Certain life events, such as moving to a new state or losing creditable drug coverage, may qualify you to change enrollment.

The Late Enrollment Penalty

The Social Security Administration applies this penalty to your Part D plan premium if you enroll in a Part D plan and one of the following is true:


  • It has been more than 63 days since you became eligible for Medicare and you don’t have creditable coverage
  • It has been more than 63 days since your creditable coverage lapsed or ended

The penalty is calculated based on the number of months you went without drug coverage once you were eligible. This increases your premium permanently. So the longer you wait, the more you will pay for the duration of your plan.

A young man is helping an older man with his medication.

What is Creditable Drug Coverage?


This refers to prescription coverage through another source that’s considered equal to or better than Part D. Examples include VA benefits, TRICARE, and some employer or union plans. If you have one of these, you should get a Notice of Creditable Coverage from your plan each year.


If you skip drug coverage when you’re first eligible for Medicare, and if you don’t have creditable coverage, you’ll pay more on your Part D premium permanently if you decide to sign up for a plan later. Similarly, if you lose your creditable coverage, you must switch to a Part D plan within 63 days to avoid the late enrollment penalty.

Part D Frequently Asked Questions

  • Do I need Part D if I don’t take many medications?

    It’s a good idea to enroll when you're first eligible, to avoid future penalties. Even if you don’t take many medications now, a plan with a low premium will offer basic protection in case there’s an unexpected change in your health status.

  • Can I switch Part D plans every year?

    Yes, you can change prescription plans during the Annual Enrollment Period. It’s smart to review your plan annually because drug formularies and costs can change.

  • Where can I find details about my prescription drug plan?

    Create an account on the Medicare.gov website to sign in and securely access your prescription drug plan details.

Medicare Part D

What is Medicare Part D

Medicare Part D is a federal program designed to help cover the cost of prescription drugs for seniors. It's an optional plan designed specifically for prescription medications offered to individuals who are eligible for Medicare, and it works with the following Medicare plans:


Original Medicare Part A (hospital)

Original Medicare Part B (medical)

Medicare Part C (Medicare Advantage)

When & How to Enroll in Part D Prescription Drug Plans

Annual Enrollment Period (AEP): Every year from October 15th to December 7th, you can make changes to your Medicare prescription drug plan. This period is crucial for reviewing and adjusting your coverage based on your current medication needs.

Initial Enrollment Period (IEP): This is the seven-month window around your 65th birthday when you first become eligible for Medicare. It starts three months before your 65th birthday, includes your birthday month, and extends three months after.

Open Enrollment Period for Medicare Advantage Plans (OEP): If you're enrolled in a Medicare Advantage plan, you can switch to a different plan or return to Original Medicare, with the opportunity to join a standalone Part D plan from January 1st to March 31st each year.

Special Enrollment Periods (SEPs): Certain life events, such as moving to a new state or losing creditable drug coverage, may qualify you for a Special Enrollment Period.

A young man is helping an older man with his medication.
A young man is helping an older man with his medication.

What to Consider When Choosing a Part D Prescription Drug Plan

Selecting the right Part D plan involves several key considerations:


Costs:  Assess the costs associated with each plan, including premiums, deductibles, coinsurance, and coverage gap.


Coverage of Medications: Review each plan's list of covered drugs, known as the formulary. Formularies are organized into tiers that dictate how much you pay. Ensure that your current medications are covered and check for any restrictions, such as prior authorization.


Pharmacy Network: Verify that your preferred pharmacies are included in the plan’s network. Additionally, some plans offer better savings if you use certain pharmacies.

Understanding Creditable Coverage & Penalties for Medicare Part D Plans

Some employer plans offer coverage that’s as good as or better than Medicare Part D. This is called “creditable coverage.” If you have creditable coverage and maintain it, you won’t face a late enrollment penalty if you later decide to enroll in Part D. However, if your employer coverage ends or you retire, you’ll need to enroll in a Part D plan to avoid any gaps in coverage.


You may face a late enrollment penalty if you do not enroll in a Part D plan when first eligible and do not have other creditable coverage. This penalty is calculated based on how long you went without coverage and is added to your premium once you enroll in coverage. It’s important to enroll when first eligible to avoid this additional cost.