If you need to enroll in Medicare Part D for the first time, typically you will do so either during your Initial Enrollment Period (IEP), the Fall Open Enrollment Period, or if you qualify for a Special Enrollment Period (SEP). Additionally, you must:
- Have Part A Part A, also known as hospital insurance, is the part of Medicare that covers most medically necessary hospital inpatient care, skilled nursing facility (SNF) care, home health care, and hospice care. and/or Part B Part B, also known as medical insurance, is the part of Medicare that covers most medically necessary doctors’ services, preventive care, hospital outpatient care, durable medical equipment (DME), laboratory tests, x-rays, mental health services, and some home health care and ambulance services.
- And, live in the Part D plan’s service area The service area is the geographic area where a Medicare Advantage Plan or Part D plan provides medical services to its members. In many plans, the service area is where your network of providers is located.
Part D Initial Enrollment Period (IEP)
Your Part D IEP is usually the same as your Medicare IEP: the seven-month period that includes the three months before, the month of, and the three months following your 65th birthday. For example, let’s say you turn 65 in May. Your IEP runs from February 1 to August 31.
The date when your Part D coverage begins depends on when you sign up:
- Enrolling during the first three months of the IEP means coverage begins the first day of the fourth month.
- Enrolling during the fourth month of the IEP or any of the three months afterwards means coverage begins the month following the month of Enrollment Enrollment is joining Original Medicare or becoming a member of a Medicare Advantage Plan or Part D plan. .
Note: If you are enrolled in Medicare because of a disability A disability is any condition of the body or mind (impairment) that makes it more difficult for the person with the condition to do certain activities and interact with the world around them. The Social Security Administration (SSA) determines disability—and eligibility for Social Security Disability Insurance benefits (SSDI)—based on whether you can work and whether your disability is likely to be permanent. (Definition from the World Health Organization) and currently pay a , once you turn 65 you will no longer have to pay the penalty. This is because you will qualify for a new Part D IEP when you turn 65.
Fall Open Enrollment
You should enroll in Part D as soon as you are eligible to avoid a potential late enrollment penalty (LEP) and gaps in coverage Gaps in coverage are services or costs that are not covered by Original Medicare, such as vision, dental, and hearing care, as well as deductibles and coinsurance. . If you do not enroll in Part D during your IEP, you can also enroll in or make changes to Part D coverage during the Fall Open Enrollment Fall Open Enrollment, also known as the Annual Election Period, occurs each year from October 15 through December 7. During this period, you can change your Medicare coverage, and these changes will take effect January 1 of the following year. You can switch between Original Medicare (with or without a Part D plan) and Medicare Advantage; join a new Medicare Advantage Plan; and enroll in Part D for the first time if you did not enroll during your Initial Enrollment Period. (You may have to pay a Part D late enrollment penalty if you newly enroll in Part D during this time, unless you have had other creditable drug coverage.) Period—but you may have a late enrollment penalty if you are using Fall Open Enrollment to enroll in Part D for the first time.
Special Enrollment Periods
Under certain circumstances, you may have an SEP to enroll in a Part D plan, including if you:
- Had creditable drug coverage
- Have job-based drug coverage through your or your spouse’s employment
- Are eligible for Extra Help
General Enrollment Period
If you enroll in Part A and/or Part B during the General Enrollment Period (January 1 to March 31 of each year), you have an SEP to join a Part D plan starting the date you submit your application for premium Part A or Part B. The SEP lasts for the first two months of enrollment in premium Part A or Part B. Your Part D coverage would begin the first day of the month following the month you enroll in Part D.