Steps to Choosing a Medicare Part D Plan

Selecting the right Medicare prescription drug plan is a major decision. You’ll be enrolled in this plan for a while, so you want to make sure it has all the features you need. Don’t be overwhelmed – let’s keep the decision process simple.

Follow the simple steps below to choose a Medicare Part D plan.

Step 1: Identify your eligibility.

Are you eligible to enroll in a Medicare Part D plan? Will you be eligible soon? Plan pricing and formularies (list of drugs) can change every year, so if you won’t be eligible for enrollment for a few years, be aware that any research or plan comparison you do now will need to be done again closer to your enrollment period.

Learn more about Medicare Part D eligibility now.

Step 2: Identify your prescription drug needs.

Is a Medicare prescription drug plan right for you? Part D plans may help lower your out-of-pocket prescription drug costs. They also protect you from the possibility of higher prescription drug costs in the future. What are your health needs? How much do you currently spend on prescription drugs? These are important questions to ask when considering what your prescription drug needs are.

Also, take into account your health and financial needs. Do you have a long-term illness that requires regular prescription drugs? Does your monthly budget only allow for a low monthly premium (and possibly a higher deductible, more restrictive formulary, or lack of additional Gap Coverage)? These are all important questions to ask.

Step 3: Compare plans and pricing.

Different providers offer different plans, and each plan may differ in terms of pricing, formularies and pharmacy networks. These are all things to take into consideration. For example, two plans might offer your prescription drugs, but one plan might offer them at a lower out-of-pocket cost. Do some research and comparison among plans to identify the one that best suits your needs. Make sure to compare:

  • Each plan’s list of drugs
  • Costs for each plan
  • Network pharmacies for each plan

Step 4: Enroll during the applicable enrollment period.

There is a specific time period when you can enroll in a Medicare Part D plan that depends on a variety of factors. For instance, as you approach age 65, Medicare allows you to enroll in a prescription drug plan beginning three months before the month of your 65th birthday, during the month of your 65th birthday, and ending three months after your birthday month. This is the Initial Enrollment Period (IEP). Note that there is an exception: if your birthday falls on the first day of any month, your 7-month Initial Enrollment Period begins and ends one month sooner. If you’re under 65, you are eligible to enroll in Medicare if you have a qualifying disability and receive a Social Security disability benefit. You will have a 7-month enrollment window that starts 3 months before your 25th month of receiving Social Security or Railroad Retirement Board disability benefits and ends 3 months after your 25th month of getting disability benefits.

If you do not have creditable insurance coverage with another plan and do not enroll during your Initial Enrollment Period (IEP), you may be subject to a Part D Late Enrollment Penalty (LEP). If you enroll in a Part D plan at a later time, the LEP may be added to your monthly Part D premium.

You may also enroll in a Medicare prescription drug plan during the Annual Enrollment Period (AEP). This occurs October 15th through December 7th of every year.

Alternately, you may enroll when you have certain life events, such as moving or involuntary loss of coverage. This is considered a Special Enrollment Period (SEP).

Your chosen plan should have details about how to enroll during an enrollment period. Learn more about when to enroll in Medicare Part D now.