Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage, or you don’t get Extra Help, you’ll likely pay a late enrollment penalty.

Medicare - Part D Creditable Coverage
Download the template (Microsoft Word .doc file).

Medicare - Part D Non-Creditable Coverage
Download the template (Microsoft Word .doc file)

Instructions

To get Medicare prescription drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.

The form should be filled out and kept in your personal files for future reference.

For further information, please visit the Official U.S. Government Site for Medicare.