Your Medicare Part D Initial Enrollment Period (IEP) is a seven (7) month window of time that starts three months
your Medicare eligibility month (or 65th birthday month), plus
the month of your Medicare-eligibility month (65th birthday month), and continues for three months
your birthday or Medicare eligibility month.
, if you turn 65 on February 10th, your birthday month is February, and your "Initial Enrollment Period" starts on November 1st (3 months before your birthday month) and continues through May 31st (3 months
after your birthday month). Your Medicare Part D IEP therefore is November 1st through May 31st.
You can use this same 7-month Initial
Enrollment Period window to enroll in a Medicare Part D prescription drug plan (PDP
) or a Medicare Advantage plan
with drug coverage (MAPD). If you have some other form of drug coverage
(such as VA coverage) and you do not want Part D prescription coverage, you can join a Medicare Advantage plan without drug coverage (MA
Question: When does my Medicare Part D drug coverage begin?
Your Medicare Part D plan begins (or becomes effective) either (1) the first day of the month of
eligibility if you enroll into a Medicare plan before your birthday (or eligibility) month or (2) the first day of the month following the enrollment month if you enroll into a Medicare plan during or after your birthday (or eligibility) month.
Continuing the example of a February 10th 65th birthday
If you turn 65 in February, your "Initial
Enrollment Period" (IEP) runs from November through May - however, your Medicare plan coverage cannot start any sooner than
the first day of your birthday month (or February). After your eligibility month, coverage will begin the 1st day of the month after enrollment. So if you enroll in a Medicare Part D plan in February, your
coverage will begin on the first day of the month following your
enrollment or March 1st.
Exception to the "birthday rule" ---
If your birthday is on
the first of the month (February 1st), then your coverage would start
the first day of the month before your birthday (January 1st).
Question: I have several health issues and use a number of prescriptions on a regular basis, when should I join a Medicare Part D drug plan?
Consider enrollment before your Medicare eligibility month.
In our example of a "February 10th birthday", this would mean enrolling into a Medicare Part D plan before February 1st. And if your health is changing, you may wish to enroll in a Medicare plan closer to your Medicare eligibility date so that you are able to choose the Medicare plan that most economically meets your health and prescription needs. For example, consider enrollment in mid-January for a February 1st start or effective date.
If you want to have Medicare coverage starting on the first day of your
birthday month (February), you should sign up for Medicare no later
than the end of January.
Question: I do not use any medications and have no health issues, when should I join a Medicare plan?
Anytime during your IEP - enrollment depends on your personal preference (or risk tolerance).
If you have no health concerns, you can enroll into a Medicare drug
plan earlier in your 7-month AEP for a February 1st
effective date, thereby ensuring drug coverage at the beginning of your
Medicare eligibility --- or you can wait and enroll later (such as at
the end of the IEP)
if you do not anticipate needing the Medicare plan coverage - and wish
to save on Medicare plan premiums.
Question: What happens if I miss my IEP and don't join a Part D drug plan when I am first eligible?
If you miss
your Medicare Part D Initial Enrollment Period, and then later join a Medicare Part D plan, you may be subject to a permanent late-enrollment premium penalty
(LEP) that you will pay in addition to your monthly premium as long as you have a Part D plan
Please read our FAQ: "I did not enroll in a Medicare Part D plan when I was first eligible, how will I calculate my Medicare Part D late-enrollment premium penalty?
Question: What if I enroll into a Medicare plan early and then change
my mind as I get closer to my Medicare eligibility month? Am I allowed to choose another Medicare plan during the IEP?
In general, once you choose a Medicare Part D or Medicare Advantage
plan during your IEP, then you will not be given an opportunity to
choose another plan, even if your health or medication needs change.
Medicare notes in the Medicare Part D enrollment manual that
individual uses his/her IEP for Part D enrollment and this enrollment
becomes effective, this enrollment period [IEP] ends."
already noted above, the effective date for Medicare Part D enrollment
during the IEP are based on the following rules:
made prior to the month of eligibility are effective the first day of
the month of eligibility. Enrollment requests made during or after the
first month of eligibility are effective the 1st of the month following
the month the request was made."
However, the Medicare
Part D enrollment manuals also take into consideration Multiple
enrollment transactions and notes that:
"[m]ultiple transactions occur
when CMS receives more than one enrollment (or disenrollment) request
for the same individual with the same effective date in the same
reporting period. . . . [and] [g]enerally, the last enrollment request
the beneficiary makes during an enrollment period will be accepted as
the PDP into which the individual intends to enroll. If an individual
requests enrollment in more than one PDP for the same effective date and
with the same application date, the first transaction successfully
processed by CMS will take effect."
As clarification, the
Medicare manuals provide the following example of multiple enrollments:
"Two PDP sponsors receive enrollment requests from one individual. PDP
#1 receives a form on December 4th and PDP #2 receives a form on
December 10. Both organizations submit enrollment transactions,
including the applicable effective date and application date. The
enrollment in PDP #2 will be the transaction that is accepted and will
be effective on January 1 because the application date on the enrollment
transaction is the later of the two transactions submitted."
(Medicare Prescription Drug Benefit Manual, Chapter 3 - Eligibility, Enrollment and Disenrollment (updated August 12, 2020))