Medicare is a national health insurance benefit given by the Federal Government to seniors above 65. The benefit provides cover under the standard healthcare law of the country. It covers hospital insurance under Part A, medical insurance and costs under Part B, advantage plans under Part C, and also pays for prescription medication coverage under Part D.

Here is a brief overview regarding Part D enrollment, penalties, and coverage under its various plans.

Enrolling for Medicare Part D
Enrollment periods can get really confusing with Medicare. But in a year, you have three opportunities to enroll for Part D benefits as follows:

• Initial Enrollment Period (IEP)
  IEP is the standard cutoff date when you first become eligible for Medicare benefits under Original Part A and B coverage. The enrollment period starts exactly three months before you turn 65 and is terminated three months after the date. For example, if you turn 65 in April, you can apply for Medicare Part D between January and June.
• January to March
  Let’s suppose you are already paying for a Medicare Advantage plan with a private insurance provider but wish to switch to the government benefits. In that case, you can opt for Part D coverage between 1^st January and 31^st March.
• Open Enrollment
  You can also enroll or make changes to your current Medicare Part D coverage in the open enrollment period between 15^th October and 7^th December.

Under exceptional medical circumstances, wherein the applicant might have a disability, ALS, or end-stage renal disease, early enrollment before 65 is permitted. Applicants already of availing Social Security Disability Insurance can also request for early enrolment under the scheme.

Part D Premium Penalty
It is necessary to understand that you may incur penalties if you delay signing up for the coverage. Simply put, if you do not avail of Medicare Part D at 65 and decide to continue without taking the benefit, a penalty will accrue for all the days you don’t have coverage. Every month you stay on Original Medicare but opt out of Part D coverage, a penalty is imposed due to negligence. It is a lifetime surcharge that is mandatorily payable.

• Limited window for enrollment
  During the IEP, you will have six months (including your birth month) to decide whether you wish to opt for Part D coverage with original Medicare. Post that, a decision needs to be taken within 63 days after the IEP is over to avoid accruing this surcharge.
• Sign up is beneficial
  So the bottom line, you ask? Simply sign up for Part D coverage even if you have credible third-party prescription coverage. Note that there are conditional terms for having private insurance benefits. In cases where employees are laid off, retire, or on termination of spousal coverage, private prescription coverage will be limited. Having Medicare Part D will allow you to bear the cost of medications, but only if you enroll during the IEP.

Medications covered under Part D
Part D pays for the following medications that qualify under the benefit scheme once your coverage is approved:

• Generic prescription (Tier 1): medications that you usually pay with minimal copayment applicable
• Branded prescriptions (Tier 2): medications that will be eligible for copayments under the benefit
• Branded prescriptions (Tier 3): medications that are eligible for a higher share of the copayment under Medicare Part D (varies depending on the brand name and share of the cost).
• Specialty prescriptions: costly branded medications wherein the major share of the cost is borne by Part D

Note that Part D also covers selective vaccines not already included in Part B under original Medicare.

What is not covered under Part D?
Medications for weight gain, sexual dysfunction treatment, symptomatic relief, cosmetic purposes, fertility drugs, prescription vitamins, and mineral and nutrient supplements are not covered under Medicare Part D. However, a handful of Medicare Plans under Part D may offer coverage for these exclusives as part of their supplemental benefits. Otherwise, by law, Part D cannot pay for these prescriptions.