Today in the United States, approximately 49 million Medicare beneficiaries who also have prescription drug coverage. You can purchase a stand-alone Medicare Part D Prescription Drug Plan (PDP) if you have Original Medicare. As an alternative, you can enroll in a Medicare Advantage (Part C) plan that includes prescription drug coverage to get these benefits, a plan sometimes referred to as an MA-PD.
Medicare Prescription Drug Plans and MA-PDs are optional for eligible beneficiaries, and coverage can be purchased through private insurance companies that work with networks of pharmacies. Enrollees pay a monthly premium and a copayment (a percentage of the drug’s cost) amount for their prescriptions that is set by the provider.
While all Part D providers are required to cover certain prescription drugs, they have further options regarding which drugs they include on their formularies (lists of covered drugs). Your prescription might not be on your plan’s formulary, so it’s important to check a plan’s formulary before enrolling if you already rely on certain medications.
If your prescription isn’t included in your plan’s formulary, or if your plan’s costs are too high for your budget, you might want to switch to a different prescription drug plan. Medicare makes allowances for changes during enrollment periods. Let’s take a look at when you can switch Prescription Drug Plans or Medicare Advantage plans with prescription drug coverage.
When can you change your Medicare prescription drug coverage?
Initial Enrollment Period
If you’re enrolling in Medicare for the first time, you can enroll in a Part D plan during your Initial Enrollment Period (IEP) which starts three months before you get Medicare and ends three months after you get Medicare. If you don’t enroll in prescription drug coverage when you’re first eligible for Medicare, and do not have other creditable coverage, you may incur a late enrollment penalty later.
During your IEP, you can get a stand-alone Medicare Part D plan if you have Original Medicare (either Part A or Part B, you don’t need both to be eligible). Or, you can enroll in a Medicare Advantage (Part C) plan that includes prescription drug coverage. To be eligible for a Part C plan, you must first be enrolled in Original Medicare Parts A and B.
If you enroll in a Part C plan during your IEP, you can switch to a different Part C plan (with or without drug coverage), or you can switch back to Original Medicare within the first three months of your Medicare enrollment.
The Open Enrollment Period (OEP)
The OEP starts on October 15 and ends on December 7 every year. During this period, you can do the following:
- Add, drop, or switch to a different Medicare Advantage plan. This means you can make changes to your prescription drug coverage by adding, dropping, or switching Part C plans.
- Switch from one Part D plan to another if you have Original Medicare
- Drop Original Medicare and enroll in a Medicare Advantage plan
- Drop your Medicare Advantage plan and revert back to Original Medicare, and enroll in a stand-alone Prescription Drug Plan at this time.
The Medicare Advantage Open Enrollment Period (MA-OEP)
The MA-OEP runs between January 1 to March 3. During this period, you can make the following changes to your prescription drug coverage:
- Switch to a different Medicare Advantage plan that includes prescription drug coverage.
- Drop your Part C plan and return to Original Medicare Parts A and B and enroll in a stand-alone Part D plan.
- If you enroll in a stand-alone Medicare Part D plan during the MA-OEP, you’re automatically dropped from your Medicare Advantage plan and returned to Original Medicare A and B.
Special Enrollment Periods
Medicare may grant you a Special Enrollment Period (SEP) if you move to a different service area, lose your current coverage, or if you get Medicaid or Extra Help. During a Special Enrollment Period, you can join or switch to a different Medicare plan. You don’t need to cancel your old Medicare prescription drug plan because it automatically ends when the new plan goes into effect.
Whenever you enroll in a new Medicare prescription drug program, your new provider sends a letter informing you when your coverage begins. If you don’t receive notification, or you have questions regarding your plan, you should contact your new insurance provider.