As you are getting ready to enroll in Medicare, it is important to understand Medicare Part D. Even if you sign up for Original Medicare (Medicare Parts A and B) or Medicare Advantage, you need a Part D plan for drug coverage.

What is Medicare Part D in Washington, D.C.?

If you are a Washington DC resident that wants prescription drug coverage through Medicare, a Medicare Part D plan is how you get it. You can either sign up for a standalone Part D drug plan or for a Medicare Advantage Prescription Drug (MA-PD) plan. Both options are provided by private insurance companies that contract with Medicare in Washington DC.

Who is eligible for Medicare Part D in Washington DC?

As long as you are enrolled in Medicare Part A and/or Part B, you are eligible for Medicare Part D. Some plans may have additional requirements, but few have any beyond living in the plan's service area. There are select times you can sign up for Medicare:

  • Initial Enrollment Period (IEP): This period is the first time you can sign up for Medicare and starts three months before the month of your 65th birthday and lasts for the three months after. Once you've signed up for part of Original Medicare, you can enroll in a Part D plan.
  • General Enrollment Period (GEP): The GEP is from January 1 to March 31 and you cannot sign up for Part D. But you can sign up for Part D after, from April 1 through June 30.
  • Annual Enrollment Period (AEP): From October 15 through December 7, those actively enrolled in Medicare may sign up for a Part D plan.
  • Medicare Advantage Open Enrollment Period (OEP): Between January 1 and March 31, anyone actively in a Medicare Advantage plan can switch back to Original Medicare, make changes to their MA coverage, and sign up for Part D if these changes lead to a loss of coverage.
  • Special Enrollment Period (SEP): If you missed all of the above periods, you would need to qualify for an SEP. For a list of special circumstances, check here.

Comparing Medicare Part D plans in Washington

Since both cost and coverage for Part D plans vary based on the insurance provider you choose, comparing plans comes down to your specific needs.

Always look at a plan's formulary first; this is the tiered list of prescription drugs the plan covers. Medications in lower tiers come at a lower cost, so be sure to check, not just for your prescription, but what tier it falls in. Compare this to the cost of the plan's deductible and monthly premium. Between your three costs, you want to make sure they balance out and that no cost is high enough to offset other savings.

If your income or resources are limited, you may want to see if you qualify for Extra Help. This program is designed to assist in paying Medicare Part D costs.

Do you have to enroll in Medicare Part D in Washington DC?

You do not have to enroll in any aspect of Medicare in Washington DC, or anywhere else in the United States. But this does not mean you shouldn't; the longer you wait to enroll, the higher the chance of developing late fees. You can avoid these fees if you get creditable coverage (coverage comparable to Medicare in options and cost) from somewhere else.

If you go 63 days or longer without drug coverage, you start to accrue late penalties that must be paid on top of your monthly premium as long as you have Medicare Part D.

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