By Christian BrinkleyLicensed agent, NC Life & Health · Updated October 6, 2026 · 3 min read
A neighbor told me last month, "I'm healthy, I take one pill a day, why would I pay for drug coverage?" It's a fair question, and the honest answer is that Part D is optional. You can skip it. What you should know before you do is how the late penalty works, because it follows you for as long as you have Medicare.
What Part D is, and who already has it
Part D is Medicare's prescription drug coverage. Original Medicare, Parts A and B, covers very little of what you pick up at the pharmacy. Drug coverage comes from a private plan you add on, or from a Medicare Advantage plan that includes it.
If you are in a Medicare Advantage plan, check whether it already includes drug coverage. Many do. In most Advantage HMOs and PPOs, joining a separate drug plan can get you dropped from the Advantage plan, so don't add one without checking first.
How the late penalty works
You get a seven month window around your 65th birthday to join a drug plan without a penalty. If you go 63 days or more without drug coverage that counts as "creditable," and then join later, Medicare adds a penalty to your monthly premium. It is 1% of the national base premium ($38.99 in 2026) for each full month you went without.
Here is what that looks like. Say you wait 12 months. That is 12% of $38.99, rounded to the nearest dime, so about $4.70 a month added to whatever your plan charges. It has no end date. It is not a lot in year one, and it is still there in year fifteen.
Creditable coverage: the one thing to check
You can skip Part D with no penalty if you already have drug coverage that Medicare calls creditable. That means it is expected to pay at least as much as a standard Part D plan. Coverage from a current employer, a retiree plan, the VA, or TRICARE is often creditable, but not always.
Your plan has to send you a notice each fall saying whether its drug coverage is creditable. Keep it. If you ever need to prove you had coverage, that letter is your proof. If you can't find it, call the plan and ask for it in writing.
What a plan can cost you in 2026
Premiums vary by plan, and some are low. Two limits are set for everyone. A plan can't charge a deductible above $615, and your out-of-pocket drug costs are capped at $2,100 for the year.
Higher earners pay an extra monthly amount on top of the plan's premium, from $14.50 up to $91 a month depending on income. That surcharge goes to Medicare, not to the plan. If your income is limited, ask about Extra Help, a Social Security program that lowers drug costs and waives the late penalty.
A way to think it through
Few prescriptions today doesn't mean few prescriptions at 72. Look at it two ways: what a low-cost plan would cost you this year, and what the penalty would add if you needed coverage later. Then decide with both numbers in front of you.
If you're not sure whether you have creditable coverage, or what a plan would cost with your actual prescriptions, bring the list and we'll check it together. No cost, and no pressure to enroll.
Questions people ask me about this
Can I sign up for Part D later without a penalty?
Only if you had creditable drug coverage the whole time, or you qualify for a Special Enrollment Period or Extra Help. Otherwise the late penalty applies for as long as you have Part D.
When can I join a drug plan if I missed my first window?
During the Annual Enrollment Period, October 15 to December 7. Coverage starts January 1 of the following year.
Does the Part D penalty ever go away?
No. It is added to your monthly premium for as long as you have Part D. It can be reconsidered if you disagree about whether you had creditable coverage.
Do I need Part D if I have a Medicare Advantage plan?
Check your plan first. Many Advantage plans include drug coverage. If yours does, you don't add a separate one.