Do I need Part D if I do not take any medications?
Almost always yes, and the reason is arithmetic rather than sales. Here is what going without actually costs.
This is one of the most reasonable sounding questions in Medicare and one of the most expensive ones to get wrong. If you take nothing, paying for drug coverage feels like paying for nothing.
The problem is that the penalty is counting whether you use the coverage or not.
How the penalty works
For every full month you go without creditable drug coverage after becoming eligible, roughly 1 percent of a national base premium is added to your Part D premium. Permanently, for as long as you have Part D.
Two years without coverage is around a 24 percent surcharge. Five years is around 60 percent. It is recalculated each year against the national base figure, so it grows over time rather than staying fixed.
The penalty never expires. It is not a one year catch up charge. Enroll at 72 after skipping since 65 and you carry that surcharge for the rest of your life.
The arithmetic
Low cost Part D plans exist specifically for people in your situation. Compare a modest premium now against a permanent surcharge later, and the math almost always favors enrolling.
There is also the coverage itself. Health at 65 is a poor predictor of health at 70. A single new diagnosis can mean a medication costing hundreds a month, and if you have no plan you wait until January to get coverage.
When you genuinely can skip it
Only if you have other creditable drug coverage, meaning coverage at least as good as Part D.
- VA prescription benefits
- TRICARE
- Most employer or union drug plans from active employment
- Some retiree drug plans
- Certain Indian Health Service coverage
Your plan must tell you each year whether its coverage is creditable, usually in a notice that arrives in the fall. Keep those notices. They are what you produce if a penalty is applied by mistake. See what creditable coverage means.
What does not count
- Prescription discount cards
- Pharmacy savings programs
- Manufacturer assistance programs
- Marketplace coverage after you are Medicare eligible
These can save you money on drugs. None of them stop the penalty clock.
What to actually do
- If you have VA, TRICARE or employer drug coverage, confirm in writing that it is creditable and file the notice.
- If you do not, enroll in the lowest cost plan that covers the basics during your enrollment window.
- Reassess each fall. If you start a medication, switch during Annual Enrollment to a plan that covers it well.
- If your income is limited, check Extra Help first. It can make coverage nearly free. See Extra Help.
See the full detail on the penalty.
Common follow-up questions
Can I enroll later when I actually need a medication?
Only during an enrollment window, and the penalty will have accrued the whole time. You could also be waiting months for coverage while paying full price.
Do prescription discount cards count as coverage?
No. They may save you money at the pharmacy but they do not stop the penalty from accruing.
What if I get all my medications from the VA?
VA coverage is creditable, so no penalty accrues. Some people still add Part D for access to civilian pharmacies, which is worth pricing.
Want this looked at properly?
We are an independent agency in McAllen serving Hidalgo, Cameron and Starr counties. No cost to talk it through.
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