2017

PLAN
INFORMATION

When to Enroll in a Medicare Part D Plan

There are three main times when you can switch or join a Medicare Part D plan.

Initial Enrollment Period
When you're turning 65

Annual Enrollment Period
Each year from October 15 through December 7

Special Enrollment Period
Under special circumstances for a specific time period

If one of these enrollment periods applies to you, and you’re looking for 2017 coverage, start by comparing plans based on where you live, the drugs you take and the pharmacies you use.

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Initial Enrollment Period

Initial Enrollment Period

When you’re turning 65, you have 7 months to enroll in a Medicare Part D plan:

  • 3 months before the month you turn 65
  • The month of your 65th birthday
  • 3 months after the month you turn 65

Your coverage start date will depend on when you join a Medicare Part D plan.
For example, suppose your 65th birthday is May 10, 2017. That means you can enroll from February 1 to August 31, 2017.

If you join a Medicare Part D plan: Coverage will start:
February 1 to April 30, 2017 May 1, 2017
May 1 to May 31, 2017 June 1, 2017
June 1 to June 30, 2017 July 1, 2017
July 1 to July 31, 2017 August 1, 2017
August 1 to August 31, 2017 September 1, 2017

If you are disabled

If you are eligible for Medicare due to a disability, you can enroll in a Medicare Part D plan anytime during the following 7-month period:

  • 3 months before the 25th month of your disability
  • The 25th month of your disability
  • 3 months after the 25th month of your disability

You can also enroll during your Initial Enrollment Period when you're turning 65.

Important: Enroll in a plan that provides prescription drug coverage during your Initial Enrollment Period to avoid paying a late enrollment penalty. If you receive Medicaid, you may be able to enroll at other times of the year without a penalty.

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Annual Enrollment Period

Annual Enrollment Period

The Annual Enrollment period for Medicare Part D, known as Open Enrollment, is October 15 through December 7 each year. This is your opportunity to switch or join a Medicare Part D plan. Outside this time period, you can make other changes during the year only if you qualify for a Special Enrollment Period.

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Special Enrollment Period

Special Enrollment Period

A Special Enrollment Period is a set period of time outside the Initial and Annual Enrollment periods when a person with special circumstances may join or switch plans. In most cases, you have up to 2 months after the month your current coverage ends to join a plan.

Here are a few ways you could qualify for a Special Enrollment Period:

  • You lose creditable prescription drug coverage (that is, coverage as good as or better than Medicare) through no fault of your own
  • You move to a new permanent address that is not in your current plan's service area
  • Your current plan no longer offers Medicare Part D coverage
  • You receive Medicaid or get Extra Help with Part D costs
  • You are enrolled in a State Pharmaceutical Assistance Program (SPAP)

If you qualify, your coverage start date will be the first day of the month following the month that the plan receives your completed enrollment request. For example, if we receive your enrollment request on June 7, your coverage will begin July 1.

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Late Enrollment Penalty

If you did not enroll in a plan that provides prescription drug coverage when you first became eligible for Medicare, or you experienced a continuous period of 63 days or more without creditable prescription drug coverage,* you may have to pay a penalty if you join a plan later.

If you must pay a late enrollment penalty, Medicare determines the amount of the penalty using a set formula.

Here’s how it works:
The penalty is 1% of the average national premium amount for every month that you didn't have creditable coverage. Medicare determines the amount of the average premium for all Medicare Part D plans in the nation. For 2017, this amount is $35.63.

To calculate the penalty amount:

  • First, count the number of full months you delayed enrolling in a plan with prescription drug coverage after your Initial Enrollment Period ended. (Or, if you have a break in coverage, count the number of full months in which you did not have creditable prescription drug coverage, if it is 63 days or more.)
  • Next, multiply 1% by the number of full months without coverage.
  • Then multiply this amount by the average monthly premium ($35.63), and round this number to the nearest 10 cents.

For example, if you delay enrollment or go for 3 full months without creditable prescription drug coverage, your monthly penalty will be:

1% x 3 = .03

.03 x $35.63 = $1.07

$1.07 rounded to the nearest 10 cents = $1.10

Your monthly premium will be $1.10 more every month for as long as you are enrolled in a Medicare Part D plan.

For more information, you can call Medicare at 1.800.MEDICARE (1.800.633.4227). TTY users should call 1.877.486.2048, 24 hours a day, 7 days a week.

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Need help?

Call 1.866.477.5703 TTY users: 1.800.716.3231
8 a.m. to 8 p.m., 7 days a week, except Thanksgiving and Christmas

*Creditable prescription drug coverage meets Medicare’s minimum standards. It is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.