Prescription Drugs, Part D

Prescription Drugs Plan D

Approximately 90 percent of people over the age of 65 take at least one drug every week, yet Original Medicare does not provide coverage for most prescription medications.

As a Medicare beneficiary, you have two primary options for obtaining coverage for prescription drugs. The first is enrolling in a Medicare Advantage plan that that provides such a benefit. The second option is enrolling in a standalone Medicare Part D plan. Because these plans are sold by private insurers, each plan will include its own criteria concerning:

• Premiums
• Deductibles
• Copayments or coinsurance
• A list of drugs covered by the plan

As of 2018, there were 22 Medicare Part D plans available in Oregon. Each plan is unique in terms of its cost and coverage, so it’s important to find a plan that fits your needs.

Eligibility and Enrollment

If you are enrolled in both Medicare Part A and Part B, you are eligible to enroll in a Part D plan or to enroll in a Medicare Advantage plan with prescription drug coverage.

There are only certain times of the year in which you may sign up for a Medicare Part D plan or a Medicare Advantage plan, which are outlined below.

Initial Enrollment Period (IEP)

Your seven-month Initial Enrollment Period (IEP) begins three months before your 65th birthday, includes the month of your birthday and continues for three months after you turn 65. 

It is important to understand that there is a Medicare Part D late enrollment penalty. You may incur this penalty if you go at least 63 continuous days without a Part D plan, a Medicare Advantage plan the offers prescription drug coverage, or other creditable prescription drug coverage.

Annual Election Period

The Annual Election Period occurs from October 15 to December 7 each year. During this time, you may enroll or disenroll in a Medicare Part D plan or switch from one plan to another. You can also enroll in a Medicare Advantage plan with prescription drug coverage, disenroll from a Medicare Advantage plan, or switch from one Medicare Advantage plan to another.

Special Enrollment Period

A Special Enrollment Period may be granted under certain circumstances under which you can enroll in a Medicare Part D plan or in a Medicare Advantage plan. These specific circumstances can include but are not limited to: moving out of your current plan’s service area, losing your current coverage or moving into a long-term care facility.

5-Star Special Enrollment Period

There is also a 5-Star Special Enrollment Period, which runs from December 8 to November 30 each year. If you are enrolled in a Part D plan or a Medicare Advantage plan that does not have a 5-star rating, you can use this time to switch to one that does, as long as one is available in your area.