When nearing Medicare eligibility, it can be challenging to decide how comprehensive your health care coverage needs to be. Enrolling in Original Medicare (Parts A and B) is mandatory, while prescription drug coverage (Part D) is optional. It is possible to enroll in an optional Part C (or a Medicare Advantage plan) instead of Parts A, B, and D, as it covers the mandatory Parts A and B (and usually includes drug coverage as well).
How do I get started with Medicare Part D?
The first thing to decide is if Medicare Part D is the right fit for you. Part D will help pay for prescription drugs and protect you from high drug costs, both for medications taken today and in the future. Having some type of prescription drug coverage (either through a Part D or private Part C/Medicare Advantage plan) is crucial for most people. Almost everyone will take prescription drugs at some point in their lifetime.
Many states have low-cost Part D plans designed to act as a safety net in case of future medication needs due to a change in health conditions. Choosing to not enroll in Part D upon eligibility at age 65 may create a lifelong penalty if enrollment is postponed.
Can you delay enrollment in Part D and keep your current drug coverage?
If you have prescription drug coverage through an employer, it is possible to delay enrollment in Part D without incurring penalties. The employer’s prescription drug plan can be kept until retirement or coverage loss if the plan allows for “creditable” drug coverage. This occurs when the employer’s drug plan is considered “as good as or better than” Medicare Part D. Your employer can confirm eligibility to delay enrollment in a Part D plan. The insurance plan should also send a letter confirming if the company’s coverage is “creditable.” Any coverage considered “creditable” (which could include coverage through a spouse’s employer or the Veteran’s Administration) allows for a delay in enrollment in Part D. For more information on delaying Part D enrollment, check out our “65 and Still Working” guide.
It is possible to enroll in Part C/Medicare Advantage instead of Part D to get drug coverage?
Medicare Advantage plans (Part C) are private health plans that have contracts with Medicare. Joining one provides Medicare-covered healthcare services through the private plan. Medicare Advantage plans must cover all the same benefits as Medicare Parts A and B, and may also cover prescription drugs. Enrolling in a Part C plan that covers prescription drugs can replace the need to enroll in Part D.
How to get help understanding Part D plans and costs
If you or an older adult you know needs help choosing a Part D plan—or getting extra help with prescription drug costs—try these resources:
- BenefitsCheckUp® is a free online tool where you can browse benefits programs to help youpay for health care and other costs, including prescription drugs.
- Your local State Health Insurance Assistance Program (SHIP) is federally funded to provide free, unbiased assistance to people with Medicare and their families. To find your SHIP, call toll-free 877-839-2675 or visit the SHIP website.
- NCOA has partnered with licensed Medicare advisers who meet our Medicare Standards of Excellence. Each one has completed a robust training and certification process, ensuring they can provide reliable, in-depth Medicare advice and support. Talking to these brokers is absolutely free. Learn more.
