Is Medicare Part D Mandatory? |

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Is Medicare Part D Mandatory?

You are not required to purchase Part D prescription drug coverage. However, if you don’t enroll when you are first eligible, you may owe a late penalty for coverage in the future. Consider this page as your guide to common questions about Prescription Drug Plans (PDPs).

What is it?

Is Medicare Part D Mandatory?Part D is prescription drug coverage available to anyone who is eligible for Part A and Part B health coverage. For people 65 or older and disabled Americans, its coverage allows access to necessary medications.

You can get prescription coverage in two ways: You can sign up for it through the federal government, along with Part A and B  (and Medigap), or you can purchase an Advantage (Part C) plan that includes coverage for prescription drugs from a private insurer. Either way, your coverage will work in conjunction with your coverage for health care services. You’ll receive at least the basic drug benefits required by law, but some plans may offer more coverage.

If I don’t sign up when I’m first eligible, can I get it later?

While you are not required to enroll in a PDP, there are disadvantages to not signing up. If you don’t enroll when you are first eligible—during your initial enrollment period*—you may owe a penalty for late enrollment.

The amount of penalty you’ll pay depends on how long you went without coverage. Here’s how the amount is calculated:

  1. Take 1 percent of the “national base beneficiary premium” ($34.10 in 2016).
  2. Multiply by the number of months you went without coverage.
  3. Round to the nearest $0.10.
  4. The penalty will be added to your regular premium, which is calculated depending on your income.

*The initial enrollment period starts 90 days prior to turning 65. You’ll be eligible on the 1st day of the month in which you turn 65.

Should I enroll in coverage?

Even if you don’t currently take medications, you may want to enroll when you are first eligible. This way, you’ll avoid having to pay the late penalty. In addition (and perhaps more importantly), you’ll have financial help paying for medications in the event you need them. If you’d be concerned about paying out of pocket for medications if you got sick, it’s probably a good idea to get this coverage.

To find out which medications are covered and how much you’ll pay, read our guide to plan coverage and benefits.

How do I get coverage?

Once you’re eligible, you have the choice to enroll in a standalone Part D Prescription Drug Plan or an Advantage Plan with Prescription Drugs (MA-PD).

  • To enroll in a PDP, you’ll need to be enrolled in Part A and/or Part B health coverage. You can choose from the plans that are available in your area.
  • For MA-PD, you can contact a private insurance company that offers Advantage plans with prescription drugs in your area.



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