ABA Family Legal Guide

The Rights of Older Americans

Health and Long-Term Care Benefits

Medicare

What is the enrollment process for Part D?

Enrollment in a Part D Prescription Drug Plan is voluntary, although a choice to delay enrollment after you initial eligibility results in a penalty - an increased premium. It is a separate from enrollment from that for Medicare. You can enroll when you first get Medicare, or during an annual enrollment period, and for certain circumstances, special enrollment periods. Medicare beneficiaries have four enrollment options:

1. Enroll in a stand-alone prescription drug plan (called a PDP).
2. Join or remain in a Medicare Advantage plan (such as an HMO or PPO) and get all Medicare and prescription drug benefits through the plan.
3. Retain your current coverage from a non-Medicare source if it is as good as Medicare. For example, if you receive drug coverage from another source, such as an employer, a union, the Veterans Administration, or a Medigap policy, you will be notified by your current plan if its drug coverage is at least as comprehensive as Medicare drug coverage.
4. Decide not to enroll in a Medicare plan at this time, and go without prescription coverage. If your current drug coverage is not at least as comprehensive as Medicare's coverage and you wait until a later time to enroll in a Medicare plan, then you will have to pay a permanently higher monthly premium for the coverage

There are many Medicare drug plans. In most states, you have a confusing array of stand-alone PDPs and Medicare Advantage Plans from which to choose. State Health Insurance Assistance Programs (SHIPs) can help you identify the most important factors to consider in making your selection, including the annual cost of a plan (i.e., the cost of premiums, deductibles, and co-payments), whether the drugs you need are included, and whether your local pharmacy is in the plan network. You can change plans annually, and because plan coverage and prices change yearly, you should review your coverage annually to make sure you have a plan that best fits you.