Whether or not you take prescription drugs, you may want to consider your options carefully when it comes to joining Medicare Part D. Unless you have other, creditable coverage offered through work or a union, going without prescription drug benefits may end up costing you money. Do you have to join Medicare Part D to avoid extra fees? Part D coverage is optional, but without the right guidance, you could end up paying a higher premium from a late enrollment penalty. Here’s some information on Part D coverage and what you should know if you are approaching your Initial Enrollment Period. 

How to Avoid the Part D Penalty

Joining Medicare Part D, or prescription drug coverage is optional. However, joining late may trigger a penalty. How do you avoid the Part D penalty?

• Join Part D when you are first eligible, during your Initial Enrollment period.
• Maintain creditable coverage (other prescription drug coverage) through an employer, union, or other health insurance provider.

If you do not currently have prescription drug benefits through an employer or other source, the best time to join Medicare Part D is when you are first eligible, during your Initial Enrollment period. Even if you do not need medications now, joining during Initial Enrollment ensures you avoid paying a late enrollment penalty.

Not everyone needs to join Medicare Part D when they are first eligible, and there are many seniors who delay enrollment without paying a penalty. Many employer-provided health insurance plans offer drug coverage that is considered “creditable” by Medicare.

If you do have drug benefits, as long as you are covered, you do not need to join Medicare Part D. However, if you lose coverage (employer benefits end or COBRA ends) you only have a certain amount of time to join Part D without penalty.

Your health insurance provider will let you know if your coverage is creditable. Be sure to keep this documentation safe as you will need to show it to Medicare when you are ready to join Part D. Without proof, you may end up paying a late enrollment penalty.

If You are Penalized, Here’s How to Calculate Your Premium

If you go without a Medicare prescription drug plan (Part D) or other creditable coverage for 63 days or more after your Initial Enrollment period ends, you may owe a late enrollment penalty. Penalties are calculated by multiplying the Part D premium amount by the number of full months you went without Part D or creditable drug coverage.

Penalties are added to your monthly Part D premium for as long as you have coverage. For example, if you went 6 months without creditable coverage, your penalty would be .06 (for 6 months without coverage) times 35.63 (Part D premium) for a total of 2.13. Medicare rounds to the nearest .10, making your penalty $2.10 added to your Part D premium. Note: penalties are recalculated as annual premiums increase.

References:

Part D Penalty:  https://www.medicare.gov/part-d/costs/penalty/part-d-late-enrollment-penalty.html

MUC56-2017-BCBS