Whether you have coverage through a standalone Part D prescription drug plan (PDP) or a Medicare Advantage plan paired with prescription drug coverage (also called MA-PD), you’ll be able to make changes to your coverage at certain times throughout the year.
Initial Enrollment Period
Medicare enrollment for those who are 65 years of age or older begins 3 months before the beneficiary’s birthday, lasts throughout the month of that birthday and ends 3 months after it. You can enroll at any point during the IEP. You can get your Medicare benefits from Original Medicare or through Part C, also known as a Medicare Advantage plan. If you join Original Medicare, you can enroll in a standalone Prescription Drug Plan (PDP) during this time. Alternatively, you can choose to enroll in a Medicare Advantage plan that includes prescription drug coverage.
Special Enrollment Period
Different factors can trigger an SEP, but the most common reason for an SEP is the loss of other coverage. This may be because a recipient moves out of the service area of their current plan or they lose coverage through a private insurer or a spouse’s private insurer. You may also qualify for a SEP if you move into in or leave a nursing home, or if you are found eligible for Extra Help for medication costs.
In order to enroll in a Prescription Drug Plan during an SEP, you must be enrolled in Parts A and B. You may also be required to prove you had creditable coverage of prescription drugs with your previous plan.
Annual Election Period
The Annual Election Period is from October 15 to December 7 each year. During this period of time, you can make changes to your Medicare coverage. For example, you can:
- Change from one Medicare Advantage (with or without drug coverage) plan to another MA plan (with or without drug coverage)
- Change from one Prescription Drug Plan to another
- Drop your Medicare Advantage plan and revert to Original Medicare. At this time, you can enroll in a stand-alone Prescription Drug Plan.
- Drop Original Medicare and PDP and enroll in a Medicare Advantage plan with prescription drug coverage
Coverage acquired during AEP begins the following January 1st.
Medicare Advantage Open Enrollment
The yearly Medicare Advantage Open Enrollment Period is for those Medicare recipients who are already in an MA Plan. During this window of time, recipients can make changes that include switching or dropping their MA-PD.
When making changes to your prescription drug coverage, make sure to consider any changes in formularies or drug tiers. Costs and coverage can vary considerably from one region to the next or between different insurance carriers.
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