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Reviewed for accuracy by Lauri Middleton, RN, MSN, licensed Medicare agentReviewed for clarity by Karen OrillaMeet our reviewers →

Decision 3 of 5

Drug coverage

Where will my prescriptions be covered, and by when?

What this is

Medicare drug coverage always comes from a private plan: a stand-alone Part D plan with Original Medicare, or built into most Medicare Advantage plans. Each plan has its own list of covered drugs, tiers and pharmacies.

After your first enrollment period, a gap of 63 consecutive days or more without Part D or other creditable drug coverage can lead to a late penalty. People who get Extra Help do not pay this penalty.

Part DPrescription drug coverage from a private plan — either a separate plan added to Original Medicare or built into a Medicare Advantage plan. Glossary →
Creditable coverageDrug coverage that is at least as good as standard Part D. Having it means no Part D penalty clock is running. Employers must tell you in writing whether theirs is creditable. Glossary →
Late enrollment penaltyAn amount added to a premium for signing up later than your windows allowed. Part B's is 10 % per full year and lasts as long as Part B; Part D's is 1 % of the base premium per month and is permanent. Glossary →
Extra HelpA Social Security program that lowers Part D premiums, deductibles and copays for people with limited income and resources. Glossary →
Applied to your calendar

Draw a calendar first and this section will use the actual dates.

Start my calendar

What changes if you wait
  • When a Part D penalty applies, Medicare counts full uncovered months at 1% of the national base premium and rounds the penalty to the nearest 10 cents. It generally lasts while you have Part D; Extra Help is an exception.
  • A plan's drug list can change each year; the Annual Notice of Change each fall is where to look.
Ask a real person
Ask your pharmacist:
Ask the benefits office (if there is job coverage):
Where things stand
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The rules we use

Drug coverage has the same first window

After your first enrollment period, a gap of 63 consecutive days or more without Part D or other creditable drug coverage can lead to a late penalty. People who get Extra Help do not pay this penalty.

Source: Medicare.gov — Part D costs and the late enrollment penalty · In effect since 2006-01-01 · Last checked 2026-09-06

Drug coverage: two months after job coverage ends

The Part D window after losing job-based drug coverage is shorter than the Part B one: two months after the coverage ends. Ask the benefits office for a letter saying whether the drug coverage was creditable.

Source: Medicare.gov — Special Enrollment Periods · In effect since 2006-01-01 · Last checked 2026-09-06

Part D late enrollment: 1 % of the base premium per month

When a Part D penalty applies, Medicare counts full uncovered months at 1% of the national base premium and rounds the penalty to the nearest 10 cents. It generally lasts while you have Part D; Extra Help is an exception.

Source: Medicare.gov — Part D costs and the late enrollment penalty · In effect since 2006-01-01 · Last checked 2026-09-06