How to Enroll in a Medicare Part D Plan

Enrolling in a Medicare Part D plan is a little bit different than signing up for Medicare Part A hospital insurance or Part B medical coverage, which are both provided by the federal government.

Medicare Part D prescription drug plans (PDP) provide coverage exclusively for retail prescription drugs, which are not typically covered by Medicare Part A or Part B (known together as Original Medicare).

To get started enrolling in Medicare Part D coverage, you can compare plans online or you can call to speak with a licensed insurance agent who can help you find plans that are available where you live.

How Do I Enroll in Medicare Part D?

Medicare Part D plans are sold by private insurance companies, and plan availability and benefits can vary based on where you live.

If you contact an insurance company directly, they may only provide you with a list of Part D plans that they sell. But if you contact a licensed insurance agent, they may be able to provide you with a list of Part D plans available for purchase in your county from a number of different carriers. 

Once you have a list of plans for your area, a licensed agent can go over the details of each plan with you, such as:

• A list of drugs that are covered by the plan (called the plan formulary)
  
  
• How much covered drugs cost, based on the tier they’re in for your plan (lower cost drugs like generic drugs are typically on lower tiers)
  
  
• Which local pharmacies are part of the plan network, and whether there are network restrictions you should be aware of with your plan
  
  
• How much the plan costs, including premiums, deductibles and copays/coinsurance

If you are eligible to enroll, a licensed agent may be able to walk you through the enrollment process step-by-step to help make sure you get signed up for your desired plan correctly, on time and without confusion.

When Can I Sign Up for Medicare Part D?

There are three times during which you may be able to sign up for a Medicare Part D plan. 

• Initial Enrollment Period (IEP)
  Your 7-month Initial Enrollment Period begins 3 months before you turn 65 years old, includes the month of your birthday and continues for 3 more months.
  
  During this period, you may sign up for Medicare Part D. If you already have a Part D plan, you also may be able to switch to another Part D plan or drop your plan to switch to or from a Medicare Advantage plan with prescription drug coverage.
  
  
• Annual Enrollment Period (AEP)
  Also called the Fall Medicare Open Enrollment Period for Medicare Advantage and Prescription Drug Plans, this period lasts from October 15 to December 7 each year.
  
  During Medicare AEP, you may sign up for, disenroll or switch Medicare Part D plans.
  
  
• Special Enrollment Period (SEP)
  Depending on your circumstances, you may qualify for a Special Enrollment Period at any time during the year.
  
  Some of the things that may qualify you for a Special Enrollment Period include moving to a new plan service area or losing creditable drug coverage through no fault of your own.
  
  A licensed insurance agent can help determine whether you are eligible for a Medicare Special Enrollment Period.

Who Is Eligible for Medicare Part D Enrollment?

Before enrolling in a Medicare Part D plan, you should check to make sure you are eligible.

To join a Part D plan, you must meet each of the following two criteria:

• You  must be enrolled in Medicare Part A.
• You must reside in the area serviced by the plan you wish to join.

How Much Does It Cost for Medicare Part D?

According to data from the Centers for Medicare & Medicaid Services (CMS), the average premium for a standalone Medicare Part D plan (PDP) in 2022 is $48 per month.¹ 

There may be several different costs associated with a Medicare Part D plan, depending on the plan:

• The premium is the amount that you pay each month to belong to the plan.
  
  
• The deductible is the amount that you must pay before your Part D plan coverage kicks in. Some Part D plans feature $0 deductibles.
  
  
• Copayments or coinsurance are the amount that you must pay for covered prescriptions after you meet your deductible (if your plan has one).
  
  A copayment is a flat fee (like $10), whereas coinsurance represents a percentage of the cost (like 10 percent).
  
  Part D plans typically have different cost-sharing levels for different tiers of drugs. As mentioned above, lower cost generic drugs are typically on a lower tier. Brand name and specialty drugs typically cost more and are usually on higher tiers.

Premiums, deductibles and copayments/coinsurance may vary.

How do I Apply for Medicare Extra Help?

Some beneficiaries with limited financial resources may qualify for the Medicare Extra Help program. This program helps PDP enrollees pay for their plan premiums, coinsurance, deductibles and prescription costs.

You may qualify for Extra Help in 2023 if you meet the following financial limits:

• Up to $22,116 per year in income ($30,000 as a married couple)
• Up to $14,790 in financial resources ($29,520 as a married couple)

Countable financial resources include things like savings accounts, stocks and bonds, but doesn’t include things like your home or other household items.

You can apply online for Extra Help by visiting the official website for the Social Security Administration (SSA): https://secure.ssa.gov/i1020/start.

You do not need to apply for Extra Help if you have Medicare and Supplemental Security Income (SSI) or if you are dual eligible for Medicare and Medicaid. If you meet either of these criteria, you automatically get Medicare Extra Help benefits.

How Else Can You Get Drug Coverage Through Medicare?

A Part D plan is not the only way to secure Medicare coverage for prescription drugs.

Medicare Part C (Medicare Advantage) plans provide the benefits of Medicare Part A and Part B combined into a single plan sold by a private insurance company.

Most Medicare Advantage plans in 2022 (89 percent, in fact) include coverage for prescription drugs.² Some Medicare Advantage plans may also offer additional benefits such as routine dental and vision coverage, transportation and hearing care coverage. 

Like Part D prescription drug plans, Medicare Advantage plans are sold by private insurance companies. Plan costs and benefits may vary based on where you live and the plans that available to you.

Can I Sign Up for Medicare Part D and a Medicare Supplement Plan?

You can have both a Medicare Part D prescription drug plan and a Medicare Supplement Insurance (Medigap) plan at the same time.

This means that you could have Medicare coverage that looks like this:

• Medicare Part A helps cover your inpatient hospital costs.
  
  
• Medicare Part B helps pay for covered outpatient care, such as doctor’s office visits and preventive care like flu shots.
  
  
• Your Medigap plan helps pay for Medicare deductibles, coinsurance and copayments that Part A and Part B don’t cover.
  
  
• Your Medicare Part D plan covers your prescription drug costs.

Call today to speak with a licensed insurance agent who can help you compare Medicare Supplement plans that are available where you live. They can also help you get started finding the right Part D plan for your needs.