Part D Enrollment Periods
| Who it’s for | When is it | What it’s for | |
| Initial Enrollment Period (IEP) | Beneficiaries eligible for Medicare Part ... | 3 months before the month of 65th birthd ... | Enrolling in Medicare Part A and/or B, P ... |
| Annual Election Period (AEP) | Beneficiaries enrolled in Medicare Advan ... | October 15 – December 7 | Enrolling, disenrolling, making plan cha ... |
| Special Enrollment Period (SEP) | Beneficiaries with special situations, s ... | Varies depending on qualifying circumsta ... | Discontinuing enrollment in an MA plan a ... |
When can I Change my Medicare Part D?
You can change from one Part D plan to another during the Medicare open enrollment period, which runs from October 15 to December 7 each year. During this period, you can change plans as many ...
When can you change Medicare Part D plans?
You can change from one Part D plan to another during the Medicare open enrollment period, which runs from October 15 to December 7 each year. During this period, you can change plans as many ...
What are the proposed changes to Medicare?
- The Biden administration’s “human infrastructure” proposal would expand Medicare coverage for dental, vision, and hearing aids.
- It also would attempt to lower the cost for prescription drugs.
- The proposal also explores the possibility of lowering the eligibility age to under 65.
How do I Change my Medicare Part D plan?
- Switch from Original Medicare to a five-star Medicare Advantage plan
- Switch from a Medicare Advantage plan with fewer than five stars to a five-star plan
- Switch from a Part D plan with fewer than five stars to a five-star plan
- Switch from one five-star Medicare Advantage plan to another five-star Medicare Advantage plan
Can you change Medicare Part D plans at any time?
You can sign up for a Medicare Part D plan or switch from one Part D plan to another during each year's open enrollment period. You also can sign up for a Medicare Advantage plan or switch to a different Medicare Advantage plan — with or without drug coverage — during that time.
Is it too late to change Medicare Part D plan?
If you are in traditional Medicare, you can switch Part D plans or switch to a Medicare Advantage plan during the Medicare Open Enrollment period that runs from October 15 through December 7; you cannot use the Medicare Advantage Open Enrollment period (from January 1 to March 31) unless you are enrolled in a Medicare ...
Can I change Medicare plans in the middle of the year?
If you're covered by both Medicare and Medicaid, you can switch plans at any time during the year. This applies to Medicare Advantage as well as Medicare Part D.
Can you change Medicare plans every year?
Typically, you can only enroll in a different Medicare Advantage Plan or switch between Original Medicare and Medicare Advantage during specific times each year. Make sure to enroll in a timely manner to avoid gaps in coverage when using these enrollment periods.
Medicare Part D Plan Options
To change Medicare Part D plans, there are specific windows of time, known as enrollment periods, that allow you to change your current Medicare coverage. To make changes outside these enrollment windows, medical underwriting may be required.
Part D Enrollment Periods
Medicare enrollment periods stay the same every year, but your coverage needs can change. Below is a chart explaining each enrollment period and what it is for. Keep reading to get important information on prescription drug coverage so you can:
Change Medicare Part D Plans Outside Enrollment Windows
If you find yourself outside the IEP and AEP, you may fall under the “Special Circumstances” category. Contact a Medicare agent who can quickly and easily tell you if your specific situation fits under one of the qualifiers for SEP.
How to Prepare for the Call
So that the agents can best assist you in navigating enrollment windows and coverage options, here are some quick tips:
How to switch medicare plans?
To switch plans, you should usually call 1-800-MEDICARE to enroll in your new plan without disenrolling from your old plan. You should be automatically disenrolled from your previous plan when your new coverage begins. To avoid gaps in coverage, try to enroll at the beginning of an enrollment period.
Why did Part D stop?
You enroll or fail to enroll in a Part D plan because of a federal employee’s error. You enroll in an All-inclusive Care for the Elderly (PACE) program.
When does a drug plan stop covering a drug?
If any of your drugs are removed from the formulary through such a mid-year change, your plan should continue to cover the drug for you until the end of the calendar year unless there are safety issues or there is a generic form of your drug. You do not get an SEP if your plan stops covering a drug you need.
Can you use MA OEP to change drug coverage?
If you want to keep your Medicare Advantage Plan, you should not use the MA OEP to change drug coverage. Under certain circumstances, you may be eligible to use a Special Enrollment Period (SEP) to make changes to your Part D coverage.
What is Medicare Part D?
Today, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that further advances the agency’s efforts to strengthen and modernize the Medicare Advantage and Part D prescription drug programs. The changes finalized today are generally effective for the 2022 plan year and will potentially lower enrollee cost ...
When will Part D start?
As part of the administration’s commitment to promoting price transparency and lowering prescription drug prices, the final rule will require Part D plans to offer a real-time benefit comparison tool starting January 1, 2023, so enrollees can obtain information about lower-cost alternative therapies under their prescription drug benefit plan.
Does Part D have a specialty tier?
Today, all drugs on a plan’s specialty tier – the tier that has the highest-cost drugs – have the same level of cost sharing. Under the final rule, CMS is allowing Part D plans to have a second, “preferred” specialty tier with a lower cost sharing level than their other specialty tier.
Do pharmacies have to disclose their performance to CMS?
Under the Part D program, plans currently do not have to disclose to CMS the measures they use to evaluate pharmacy performance in their network agreements. CMS has heard concerns from pharmacies that the measures plans use to assess their performance are unattainable or otherwise unfair.
How many Medicare Part D plans are there in 2020?
There are 40 to 50 Medicare Part D plans available in each state in 2020. Narrowing so many choices down to your top contenders can be time-consuming. Medicare’s online plan finder tool makes plan comparison much easier. When you’re searching for a new plan, consider these factors:
What happens if my Medicare plan changes?
If your plan changes its contract with Medicare Medicare will determine your special enrollment period on a case-by-case basis. There are several other circumstances that could qualify you for a special enrollment period. The full list is on Medicare.gov.
How to change Medicare Advantage plan?
If you have a Medicare Advantage plan that doesn’t include drug coverage and you also have a Part D plan, you can change it during the Medicare Advantage open enrollment period, which runs from January 1 to March 31 each year. If you choose this route, you must do one of the following: 1 Change your Medicare Advantage plan to one that includes drug coverage (about 90 percent of them do). 2 Switch from Medicare Advantage back to Original Medicare, then purchase a standalone Part D plan.
How many stars are there for Medicare Advantage?
Medicare Part D plans, along with Medicare Advantage plans and Medicare Cost plans, are rated on a scale of 1 to 5 stars based on quality and performance. A 5-star rating is the highest. If you want to switch to a 5-star plan, you can do so one time between December 8 and November 30 of the following year.
When does Medicare Advantage open enrollment start?
If you have a Medicare Advantage plan that doesn’t include drug coverage and you also have a Part D plan, you can change it during the Medicare Advantage open enrollment period, which runs from January 1 to March 31 each year .
When does SEP end?
These circumstances include: If you move to an area where your current Part D plan isn’t available If you notify your current plan before you move, your SEP begins the month before you move and ends two full months after you move.
Can you switch Part D plans?
The good news is that you can switch plans. The bad news is that you can switch only at certain times of the year. This means that you need to be ready. Read what follows for some solid advice and simple tips on changing your Part D plan.
What to do if you have Medicare Part D?
If any of the following situations apply to you, it could pay to swap your current plan for a different one.
What to do if your prescription changes?
If your prescription changes, a plan switch could save you money. If your plan doesn’t have one or two conveniently located pharmacies in-network, that alone is a good reason to contemplate a switch. If you’re paying a high premium for a plan you’re hardly using, consider a lower-cost plan. If you have Medicare Part D coverage, you’re no doubt ...
Can you change your Medicare Advantage plan during the open enrollment period?
Note that if you have Original Medicare, you cannot make changes to your coverage during the Medicare Advantage Open Enrollment Period, but can make those changes during Fall Open Enrollment.) 1. Your current plan’s formulary has changed. All Part D plans—including MA-PDs—have a formulary that places medications into different tiers.
Does Part D cover prescriptions?
It always pays to find a Part D plan that offers decent coverage for the specific medications you take . But once your prescriptions change, it absolutely pays to see if there’s a plan that might offer you a better deal.
Do generic drugs have copays?
Drugs in a lower tier—usually generics—typically come with minimal copays. Some can even be copay-free. But the higher a tier you’re looking at for the medications you take, the greater your out-of-pocket costs will be. Now here’s the problem with plan formularies – they can change from year to year.
Is it worth paying for Part D?
Sometimes, it’s worth paying up for a Part D plan that offers better coverage, because what you fork over in premiums, you make up for in copays. But if you don’t have any ongoing prescriptions, then you may be better off opting for a lower-cost plan.
Do you have to fill prescriptions in MA PD?
Part D plans—including MA-PD plans—typically require enrollees to fill prescriptions at in-network pharmacies. If you use an out-of-network pharmacy, you may end up having to pay the full price for your medication, depending on the circumstances. If the plan you’re on doesn’t have at least one or two conveniently located pharmacies in-network, then that alone is a good reason to contemplate a switch. This holds true even if you have access to a mail-order program, since waiting for medications to arrive isn’t always an option.
Each "Part" of Medicare changes at least a little every year - including Part D prescription drug coverage
Since it was first introduced in 2006, Medicare Part D has gone through numerous changes. One that may be surprising, given the general rise in healthcare costs, is the government's attempts to lower prescription drug costs. For example, closing the donut hole was a provision of the Affordable Care Act (ACA, also known as Obamacare ).
How does pricing work under Medicare Part D?
Most people don't know about the four phases of Medicare Part D. And you have to in order to understand the donut hole and pretty much all of your out-of-pocket costs for your prescription drug plan.
Medicare Part D changes in 2022
Now that the donut hole closed, the big news for Part D is the rising costs of prescription drug plans (PDPs) coupled with the fact that most people will have fewer plans to choose from, thanks to the consolidation of PDPs offered by Cigna and Centene.
Medicare Part D proposals
The year 2021 saw a big push to let Medicare negotiate drug prices, with President Biden including this ability in the Build Back Better (BBB) framework. Democrats are confident this legislation will pass in 2022, which should result in huge savings at the pharmacy for everyone - not just those enrolled in Medicare.
Do You Need Help Finding a Medicare Part D Plan?
Comparing your Medicare Part D options can be confusing. Our Find a Plan tool makes it easy. Just enter your zip code, estimated start date, and hit Continue. To make it even simpler to compare options, enter any prescriptions you currently take and your preferred pharmacy.
