Are you entitled to enroll in a MEDICARE approved prescription drugs plan and haven’t?

 There are three vital questions to ask yourself.

  1. Do I need to enroll in a prescription drug plan?
  2. When should I enroll in a prescription drug plan?
  3. What type of plan is right for me?
  4. ‘Creditable’ prescription drug coverage


Medicare Part D


Medicare Advantage Prescription Drug plan

Note: You may not have coverage from more than one of these categories at any one time.

Question number 1

Do I Need To Enroll In a Prescription Drug Plan?

The short answer is YES!

Although PART D and ADVANTAGE PRESCRIPTION plans are ‘optional’, there are time-related late-enrollment penalties, and when you do apply for cover, your premiums will be higher for the duration of your coverage. In the meantime, and more importantly, you will be entirely responsible for the cost of prescription drugs not covered by Medicare (Parts A&B).

Question number 2

When Should I Enroll?

The short answer is NOW or AS SOON AS YOU ARE ELIGIBLE!

IF you are approaching retirement or working beyond the age of 65 (and have your health insurance through your employer or other group schemes) you should check with your employer to confirm the date on which your ‘credible’ prescription drug coverage ceases. From that date, you have 63 days to enroll in Medicare.  Check that your ‘credible’ insurance meets your anticipated needs. Take advice, but normally you should keep your group coverage as long as possible.  If you are not part of a group insurance plan, your 65th birthday is the key date.  This defines the special enrollment window that is your opportunity to review your health insurance strategy. You have three months before your birth month and the three months following to enroll.

Your research should start now!  Talk to a Health Exchange adviser for free independent advice.

As a minimum, you must be enrolled for Medicare (Part A).  If you (or your spouse) have paid Medicare taxes for ten years (40 quarters) the Medicare (Part A) premium will be zero but remember this does not include prescription drugs coverage.

If you do not enroll during your Initial Enrollment Period (IEP) you may face penalties. In the case of prescription drug coverage, this may result in increased premiums for as long as you have Medicare part D.

What Happens If I Miss (have missed) My IEP?

If you did not enroll in a prescription drug coverage plan at the first opportunity make sure you do so at the next.

The Annual Election Period (AEP) or Open Enrollment Period (OEP) for Medicare Advantage and Medicare prescription drug coverage runs from OCTOBER 15th – DECEMBER 7th each year.

This window provides you with the opportunity to enroll in a Medicare prescription drugs program or a Medicare Advantage prescription drugs program.  Take the opportunity to make sure that any penalties are minimized.

The same window (October 15th – December 7th) gives you the annual opportunity to

  • Switch from one Medicare prescription drug plan to another Prescription drug plan
  • Switch from a Medicare Advantage plan which does not include drugs coverage to one which does

It makes sense to review your health insurances at least once a year

  • your circumstances may have changed
  • the terms of your plan may have changed
  • there may be alternative plans on the market
  • Your anticipated prescription needs may be different. 

It pays to re-assess. You can compare plans in confidence, on-line or talk to an advisor to assess any changes.

You may take advantage of the NEW 5-Star rating system which grades all plans offered on the Health Exchanges.  If you are considering a 5-star plan you may exercise your option to change at any time but you may do so only once in the plan year.  Remember, the Star rating is a reflection of Quality and Value underwritten by the CMS and a requirement for all plans made available through Health Insurance Exchanges.

If you do nothing else, make a note in your calendar.  These dates are FIXED.  There are some personal events that qualify you for a Special Election Period (SEP).

Special Election Periods

There are some less predictable events that create a time-limited period in which Medicare-eligible citizens can apply for, change or opt-out of their existing Medicare Part D Prescription Drug Plans.

Examples are: –

  • You move out of your current plan’s service area
  • Your insurer ceases to be contracted to Medicare
  • Your ‘credible’ prescription drug coverage ends or the coverage is no longer considered ‘credible’
  • You move to a caring environment such as a nursing home

You may also be entitled to an SEP if for financial reasons you qualify for Extra Help.

Question number 3

What Type of Plan is Right For Me?

Our First Advice is, Take Advice!

Any exchange FEDERAL, STATE or PRIVATE will freely give you impartial advice.  Take advantage, either by calling or on their websites, to check out your options.

  • Medicare Part D provides Stateside coverage but offers no ‘out of pocket’ limits
  • Medicare Advantage plans offer cost-effective health insurance coverage tailored to family needs.  You can establish ‘out of pocket limits’

When we know what you need, we can put choices at your fingertips within moments!