| Thu, Aug 04, 2011 @ 09:00 AM

Can I delay enrolling in a Medicare drug coverage plan because I’m covered elsewhere?

Posted by Medicare Made Clear

Learn how Medicare Part D prescription drug coverage works, and what to do if you have existing coverage and want to delay enrolling in a Part D plan.

Prescription drug coverage isn’t automatically included in Original Medicare, but Medicare Part D prescription drug coverage is available to Medicare beneficiaries who want it. If you will continue to have coverage elsewhere (through an employer, for example) when you’re first eligible for Medicare, you may want to delay enrollment and avoid the Part D premium.

If you can show that you have creditable coverage when you are first eligible for Original Medicare and don’t opt for Part D, you may still be able to sign up later without a penalty.  You must provide documentation that you have “creditable coverage” to avoid a penalty. Creditable coverage is coverage that Medicare deems to be at least as good as a Part D prescription drug plan.

Is a Part D prescription drug plan right for me? It’s a good idea to consider Medicare Part D prescription drug coverage if you’re eligible for Medicare and don’t have drug coverage elsewhere. Medicare Part D has premium payments, so if you have creditable drug coverage (through an employer, for example), it may be unnecessary to join Medicare Pare D immediately.


Are there penalties for delaying Part D enrollment? Here are a few ways to avoid paying a penalty on your Medicare Part D premium:

  • Join a Medicare drug plan during your Initial Enrollment Period* (IEP), when you’re first eligible. You won’t have to pay a penalty, even if you’ve never had prescription drug coverage before.
  • Don’t go 63 days or more in a row without a Medicare drug plan or other creditable coverage. Creditable prescription drug coverage could include drug coverage from a current or former employer or union, TRICARE, Indian Health Service, Department of Veterans Affairs, or health insurance coverage.
  • If you delay because you have other creditable coverage, make sure you can prove it. Your plan will send you the documentation you’ll need.

How do I know if my current coverage is “creditable”? When you become eligible for Medicare, your health plan is required to tell you whether it meets the Medicare creditable coverage guidelines and to give you documentation that shows this. You’ll need this information to decide whether to enroll in a Part D prescription drug plan. Learn more about enrollment windows and timing

There are benefits to understanding your pre-existing coverage in order to time enrollment and make sure your plan is right for you. Having the knowledge now may save you from penalties later.

*Your Initial Enrollment Period (IEP) is the window of time you have to enroll without penalty when you first become eligible for Medicare. For most, it’s the seven-month period that begins three months before the month you turn 65 and ends three months after the month you turn 65.

For more information contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. You can also contact Medicare Made Clear to learn more at 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.


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