Do I have to have a Medicare Part D plan?

Whether you need a Medicare Part D plan depends on your specific circumstances, but there are potential consequences if you go without creditable drug coverage for a continuous period of 63 days or more after your Initial Enrollment Period ends [1].

What happens if I refuse Medicare Part D?

If you refuse Medicare Part D (prescription drug coverage) without having other "creditable" drug coverage (like a good employer plan), you'll face two main consequences: you'll have no prescription coverage if you need it, and you'll likely pay a lifetime late enrollment penalty added to your Part D premium if you enroll later, calculated as 1% of the national base premium for each uncovered month. To avoid penalties, sign up during your Initial Enrollment Period (IEP) or prove you had creditable coverage. 

Are seniors required to have Medicare Part D?

No, Medicare Part D drug coverage is not mandatory, but it's highly recommended, as you'll likely face a permanent late enrollment penalty if you delay signing up without having other "creditable" drug coverage (like an employer plan). This optional prescription drug benefit helps pay for medications through private plans, but delaying enrollment when first eligible and without other coverage means paying extra for the rest of your Medicare life. 

When did Medicare Part D become required?

In 2003, Congress signed into law the Medicare Prescription Drug, Improvement and Modernization Act. This law includes a prescription drug benefit called Medicare Part D. This new law makes prescription drug coverage available to all Medicare beneficiaries beginning January 1, 2006.

Is Medicare Part D deducted from my social security check?

To be enrolled on Part D, you must enroll through one of the prescription drug companies that offers the Medicare Part D plan or directly through Medicare at www.Medicare.gov. You can pay premiums directly to the company, set up a bank draft, or have the monthly premium deducted from your Social Security check.

How Medicare Part D Works (2025)

Why am I paying for Medicare Part D?

What's Medicare Drug Coverage (Part D)? Extra coverage people with Medicare can choose to help lower costs of prescription drugs. Medicare-approved private plans offer this coverage. You'll pay an extra 1% for each month you could have signed up for Part D, but didn't, and didn't have creditable drug coverage.

What are the disadvantages of Medicare Part D?

Medicare Part D's disadvantages include its complexity (choosing from many plans with varying costs, formularies, and rules), the risk of falling into the "donut hole" (coverage gap), prior authorization & step therapy requirements, pharmacy network restrictions, potential for annual plan changes, and penalties for late enrollment, making it a confusing maze of costs and limited coverage options for beneficiaries.
 

Is everyone enrolled in Medicare Part D?

Part D is optional and only provided through private insurance companies approved by the federal government. However, Part D is offered to everyone who qualifies for Medicare. Costs and coverage may vary from plan to plan.

What is the most popular Medicare Part D plan?

While no single plan is "most popular" everywhere, UnitedHealthcare (AARP) and Wellcare consistently rank high, with UHC praised for overall quality, network, and low deductibles, and Wellcare often noted for lowest premiums (like their popular Wellcare Value Script). Humana also stands out for $0 premium options and low generic costs in plans like Humana Value Rx, while Cigna and Aetna are strong contenders, making the best choice dependent on your specific drugs and location. 

Why is Social Security no longer paying Medicare Part B?

Social Security stops paying your Medicare Part B premium (by stopping deductions from your check) usually because you enrolled in a plan that covers it (like some Medicare Advantage plans with a "giveback"), qualified for extra help/Medicaid, your income changed, or there was an administrative error, meaning you'll get a higher SS check but now must pay Medicare directly or risk losing coverage, as the agency sends you a bill instead. 

What are the biggest mistakes people make with Medicare?

Here are some of the biggest Medicare mistakes to avoid:

• Missing the initial enrollment window. ...
• Assuming Medicare covers everything. ...
• Overlooking the benefits of supplemental coverage. ...
• Forgetting to enroll or re-evaluate prescription drug coverage. ...
• Not comparing plans regularly.

Is there a penalty for not enrolling in Medicare Part D at age 65?

The Part D late enrollment penalty is calculated by multiplying 1% times the “national base beneficiary premium” ($36.78 in 2025, $38.99 in 2026) times the number of full, uncovered months you were eligible to join Medicare drug coverage but didn't (and didn't have other creditable prescription drug coverage).

Is it better to go on Medicare or stay on private insurance?

Neither Medicare nor private insurance is universally "better"; the best choice depends on individual needs, as Medicare offers standardized coverage, lower admin costs, and broad access (Original Medicare), while private insurance often provides family coverage, potential out-of-pocket maximums (in MA plans), and network flexibility, but usually at higher premiums. Key differences involve cost structures (Medicare's lower admin vs. private's potential for higher costs/premiums), coverage specifics (Original Medicare's lack of an out-of-pocket cap vs. private/MA plans), and family eligibility (private covers dependents, Medicare doesn't). 

What happens if I don't have Part D?

If you don't sign up for a Part D plan when you are first eligible to do so, and you decide later you want to sign up, you will be required to pay a late enrollment penalty equal to 1% of the national average premium amount for every month you didn't have coverage as good as the standard Part D benefit.

How can I opt out of Medicare Part D?

Mail or fax a signed written notice to the plan telling them you want to disenroll. Submit a request to the plan online, if they offer this option. Call the plan and ask them to send you a disenrollment notice. You'll have to complete, sign and send the notice back to the plan.

How do I get my Part D penalty waived?

You can get a Medicare Part D late enrollment penalty waived if you qualify for Extra Help, have creditable prescription drug coverage (from an employer, VA, TRICARE, etc.), or lose employer coverage, but you have the right to appeal if you believe the penalty was miscalculated or you had good cause. Waivers aren't automatic; you must prove continuous, similar-value coverage or qualify for Extra Help, and if you disagree with a penalty, file an appeal within 60 days using specific forms. 

Is Medicare Part D worth it for seniors?

While the lower-tier drugs may be manageable to pay for without Part D coverage, the higher tiers may give you sticker shock. So, while you may have to pay a premium, deductible, copay or coinsurance, your overall Medicare Part D costs will likely be significantly less than if you don't have coverage.

How can I lower my Medicare Part D prescription costs?

To lower Medicare Part D costs, use generics, check mail-order/network pharmacies, apply for Extra Help or State Programs if low-income, ask your doctor about cost-saving options, and compare Part D plans yearly for better formulary/tiers, with options like the new Medicare Prescription Payment Plan for budgeting. 

What is the monthly cost of Medicare Plan D?

The premium is the monthly cost of maintaining your prescription drug policy. Premiums for Medicare Part D differ from plan to plan. But the average estimated premium in 2026 is $34.50.

Who should not enroll in Medicare Part D?

When you become eligible for Medicare, you should enroll in a Part D plan unless you have other creditable prescription drug coverage. Creditable drug coverage is coverage that is considered to be as good as or better than Part D.

Is Medicare D optional?

Enrollment in Part D is generally voluntary, however, some people are required to be enrolled, and others should not enroll. People who have Medicare and who receive assistance under certain federal programs (Medicaid, Medicare Savings Programs, SSI or the Part D Low Income Subsidy) are required to enroll.

What is the best drug plan for Medicare Part D?

The "best" Medicare Part D plan depends on your specific drugs, but top-rated providers often include UnitedHealthcare (AARP), Humana, Cigna, Wellcare, and Aetna, praised for broad coverage, customer service, and cost-effectiveness, with options like Humana Walmart Value Rx or Wellcare Value Script offering low costs for specific needs. Always use the official Medicare Plan Finder at medicare.gov/plan-compare/ to input your drugs and ZIP code for personalized comparisons.
 

Are you penalized for not having Medicare Part D?

The penalty for not having Medicare Part D (prescription drug coverage) is a permanent late enrollment penalty added to your monthly premium, calculated as 1% of the national average premium for each full, uncovered month you were eligible but didn't sign up (and lacked other creditable coverage). This penalty is added to your Part D or Medicare Advantage plan premium for as long as you have coverage, so it's best to enroll during your Initial Enrollment Period or have other creditable coverage to avoid it.
 

Why is it not a good idea to have supplemental insurance?

One of the most significant drawbacks of supplemental insurance policies is the coverage limits. For instance, with Mechanical Repair Coverage, you'll typically need to pay out of pocket until your deductible is met on your primary policy before supplemental insurance takes over to cover a costly vehicle repair.

What are the 5 things Medicare doesn't cover?

Some of the items and services Medicare doesn't cover include:

• A heart valve repair or replacement.
• An organ transplant.
• Cancer-related treatments.
• Dialysis services for the treatment of End-Stage Renal Disease (ESRD)