If you are enrolled in Original Medicare (Part A and Part B), you will also need to enroll in a Medicare prescription drug plan. If you are configuring your Medicare coverage under Original Medicare you will need to enroll in a stand-alone Prescription Drug Plan, also known as a Medicare Part D plan. If you are configuring your Medicare coverage with a Medicare Advantage plan, most of those plans include drug coverage, but there are some that don’t. In that case, you would need to enroll in a stand-alone prescription drug plan. Not enrolling at the right time can cause a Late Enrollment Penalty that adds additional costs to your monthly premium and stays with you for the rest of your life.
There are special exemptions from enrolling in prescription drug coverage, including if you have prescription drug coverage through work or military coverage. Please note that COBRA coverage after age 65 when you (or a covered spouse) are not actively employed will not be considered an exemption from having this coverage.
When to Change Your Part D:
You can change your Medicare Part D and Medicare Advantage plan during the Open Enrollment period, which is annually from October 15th to December 7th. The new coverage will begin on January 1st of the following year.
If you miss your initial enrollment period when you turn 65, you can sign up for Medicare and its various parts during the General Enrollment Period which is annually from January 1st to March 31st. However, you may incur a late enrollment penalty fee and your coverage will begin on July 1st of that year.
If you are enrolled in a Medicare Advantage plan (that does not include prescription drug coverage) and a Part D plan, you can change your Part D plan during the Medicare Advantage Open Enrollment period, which is every year from January 1st to March 31st. During this time, you can also enroll in a new Medicare Advantage plan with prescription coverage or just change your Part D plan. The new coverage will begin the month after you make changes to your plan(s). Please note that this enrollment period differs from Open Enrollment in the fall because it is limited to Medicare Advantage plans.
There are also special enrollment periods (SEPs) that allow you to enroll in or change your Part D coverage. This includes if you move to a different zip code, lose employer coverage (which includes prescription drug coverage), or want to join a 5-star plan (this type of SEP is only available once a year between December 8th and November 30th).
Deciding to change your Medicare Part D plan is something to consider every year. Prescriptions may change throughout the year and the way drug plans price their drugs can change significantly year over year. If you just joined a Part D plan in the past year, you are entitled to Medicare Trial Rights that allow you to change plans without underwriting. Otherwise, you will have to wait until each year’s open enrollment period to change plans.
Things to Consider When Deciding to Switch:
- Premiums: The lowest monthly premium isn’t always the lowest cost overall. It’s important to consider the individual costs of the drugs you take for each plan as well.
- Drug Costs: Each drug plan has its own formulary and separates drugs into different tiers, which affects overall drug costs. If you have high-cost drugs, check out the plan’s formulary online or with the insurance plan to understand your drug costs.
- Pharmacy: The pharmacy you use can also have an impact on the best plan for you. Changing pharmacies can often result in lower overall costs, if you’re willing to do so.
- Deadlines: Be aware of Medicare’s late enrollment penalty fee. If you go 63 days without prescription drug coverage, you may be subject to a fine that lasts the rest of the time you are on Medicare. This LEP also does not go away when you switch drug plans.
- Coverage Gap Coverage: Medicare drug coverage does not have an out-of-pocket maximum. If you have a lot of prescription drugs, you may want to learn more about the Medicare coverage gap, otherwise known as the “Donut Hole.”
- Prior Authorization Restrictions: If you went through a prior authorization or step therapy process for any of your current medications, expect to complete this process again when you switch plans since each plan has its own restrictions on what drugs are deemed medically necessary for your health condition.
Making the Switch:
Call 1-800-MEDICARE (TTY 1-877-486-2048), use Medicare’s online plan finder tool, mail in your plan-specific enrollment form, or call the plan provider. When you enroll in your new plan, you will be automatically dis-enrolled from your previous plan. Caribou can assist you with your analysis to change your Part D plans based on current and future life events.
Learn More:
How to switch your Medicare drug plan | Medicare.gov
Last Revised September 9th, 2022
