When it comes to knowing your Medicare enrollment periods, you probably have them circled on the calendar. If not, it might be a good idea to have that visual reminder because missing your enrollment (or re-enrollment) window can lead to costly penalties!
When enrolling in Medicare, it can be easy to overlook enrolling for Part D prescription drug coverage, especially if you are not currently taking any prescription medications. It’s not included in Original Medicare. So when should you enroll in Medicare Part D and how can you avoid the costly premium penalty? Let’s look at the Medicare Part D enrollment deadlines, why timely coverage matters, and what penalties you could face if you don’t enroll on time.
How Wandacare Can Help with Medicare Part D Enrollment
During your Initial Enrollment Period, the Wandacare team assists you in choosing the right Medicare parts and plans. Federally managed Original Medicare does not include Medicare Part D prescription coverage; only Medicare Part A (hospitalization coverage) and Medicare Part B (medical insurance coverage).
All Medicare Part D plans are offered by private insurance companies. The Wandacare team can help you choose to add a private Medicare drug plan when you enroll in Original Medicare.
If you choose a private Medicare Advantage Plan (Medicare Part C), your Part D coverage will be bundled with your Part A and Part B coverage, along with additional benefits, like dental and vision plans, wellness and fitness programs.
Enrolling in Medicare Part D can be a crucial step in securing prescription drug coverage that aligns with your healthcare needs. Allow the experts at Wandacare to guide you seamlessly through the process.
Understanding Medicare Part D Enrollment Periods and Deadlines
The enrollment deadlines for Medicare Part D are similar to those for all Medicare parts and plans.
The team at Wandacare can help you first choose and enroll in a Part D prescription plan during your Medicare Initial Enrollment Period (IEP), which begins three months before your 65th birthday, includes your birthday month, and continues for three months after your birthday month.
You also may be able to enroll in a different Part D plan at a later date if you qualify for a Special Enrollment Period (SEP). For example, if you elect not to enroll for Part D during your IEP because you have other creditable prescription drug coverage (e.g. from a spouse’s plan, an employer or union plan, or other federal plan like from the VA), but then that coverage eligibility ends, you could qualify for an SEP.
You have the opportunity to review and update your Part D prescription drug coverage every year during the Medicare Annual Enrollment Period, which runs from October 15 to December 7. If your Part D coverage is part of a Medicare Advantage Plan, you’ll have a second opportunity to make a single change during the Medicare Advantage Open Enrollment Period.
Missing your Part D enrollment period deadline and failing to have “creditable coverage” (more on that below) can result in costly penalties added to your monthly premium when you do enroll.
The Part D Late Enrollment Penalty and How It’s Calculated
Wandacare assists you in understanding the consequences of delaying Medicare Part D enrollment. If you delay choosing and enrolling in a Medicare Part D plan during your Initial Enrollment Period and go without Part D or other creditable prescription drug coverage for 63 days or more in a row, you’ll be assessed the late enrollment penalty (LEP).
The penalty is calculated by multiplying 1% of the monthly “national base beneficiary premium” ($34.70 in 2024) times the number of full months you didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.
For example: You didn’t enroll in a Part D plan during your IEP and waited a whole year to enroll during the next Annual Open Enrollment period. If you don’t have creditable coverage during that 12 months, your penalty and new premium would be calculated as:
.12 (12% penalty) × $34.70 (2024 base beneficiary premium) = $4.16
$4.16 rounded to the nearest $0.10 = $4.20
$4.20 is the LEP added to your monthly Part D premium for 2024.
Once the late enrollment penalty is added to your monthly Part D premium, you’ll have to pay the assessed penalty for as long as you have Medicare drug coverage. Your LEP will be recalculated every year and will be based on that year’s national base beneficiary premium.
Don’t let Medicare Part D enrollment penalties be confusing. The team at Wandacare will help you navigate these complex calculations and deadlines for you – so you don’t have to worry about these complicated math formulas.
Creditable Prescription Drug Coverage
So how can you avoid getting stuck paying the late enrollment premium penalty for the rest of your Medicare life? Enroll on time with the help of the Wandacare Team—secure your Medicare drug coverage as soon as you become eligible!
But what if you’re still working and have employer coverage when you turn 65? Or you’re eligible for other federal coverage, like through VA benefits? These can be considered “creditable drug coverage”—prescription drug plans that are equivalent to Medicare Part D prescription drug coverage and allow you to delay choosing and enrolling in a Part D plan without facing the premium penalty.
How can you know for sure that your current drug plan will count as “creditable coverage,” especially if you have an employer or healthcare marketplace plan? As soon as you become eligible for Medicare, your plan administrator is required by the Medicare Modernization Act to provide a written disclosure informing you whether your prescription drug coverage is considered creditable coverage, and/or if your coverage will change because of your Medicare eligibility. If you do not receive this disclosure or it is not included in your plan benefits handbook, contact your plan administrator.
Avoiding the premium penalty with creditable coverage with Wandacare:
- The Wandacare team will help verify that your current drug coverage counts as creditable coverage and how long you’ll be covered.
- If it’s not creditable coverage, the team at Wandacare will help you enroll in a Medicare Part D plan within your initial enrollment period.
- If your creditable coverage plan changes or ends, Wandacare will help you enroll in a Medicare Part D plan within 63 days of losing/leaving that plan.
Making Informed Medicare Part D Choices
When it comes to Medicare Part D coverage, you have a lot of choices and a lot of information to verify, especially if you’re planning to work beyond age 65 and have employer healthcare coverage. That doesn’t mean you have to sweat your coverage eligibility or chase down plan information on your own.
With over a decade of experience, Wandacare’s licensed Medicare agents and advisors can assess your eligibility and current coverage to ensure you have a prescription drug plan that meets your needs and Medicare’s requirements, with no lapse in coverage. No premium penalty for you!
Contact Wandacare today to get your coverage questions answered!
