Do I need Medicare Part D if I don't take any prescriptions?

No — Part D is optional, and nobody can make you buy it. But if you go 63 days or more without Medicare drug coverage or other creditable drug coverage, a penalty of 1% a month gets added to your premium when you finally do sign up, and for most people it stays there for life. That is the whole answer, and it is why the advice sounds so unhesitating: the plan you do not need yet almost always costs less than the penalty for not having it.

I get this question more in north Peoria than anywhere else in the practice, and I understand why. A 65-year-old in Vistancia or Trilogy who plays golf four mornings a week, takes nothing, and has never had a prescription that lasted longer than a course of antibiotics is being asked to pay every month for something with no visible use. That is not an unreasonable objection. It is just an incomplete one, because it prices the plan and not the alternative.

From today, the next ordinary chance to add drug coverage opens on October 15 — 55 days from now — and closes December 7.

What the penalty actually costs

Medicare publishes the arithmetic, so there is no need to guess at it. The penalty is 1% for each month you went without creditable drug coverage, and the percentage is applied to the national base beneficiary premium — a figure Medicare sets each year, $38.99 for 2026. It is added to whatever your plan’s own premium is, and it is recalculated every year against the new base figure.

Medicare’s own example: wait 14 months, owe a 14% penalty. That is $38.99 × 0.14 = $5.46, rounded to the nearest ten cents, so $5.50 a month on top of the plan premium in 2026.

Penalty percentages and the $38.99 national base beneficiary premium: Medicare.gov, "Avoid late enrollment penalties," 2026. Monthly amounts are that base multiplied by the penalty percentage and rounded to the nearest ten cents, as Medicare does. The base premium changes annually, so these figures move with it.

Read the bottom row honestly and you will see why people talk themselves into skipping it. Seven years of no drug plan buys a penalty of about thirty-three dollars a month — real money, but not catastrophic, and less than seven years of premiums would have been.

Two things spoil that arithmetic.

The first is that it is permanent. Thirty-three dollars a month from 72 to 90 is not a rounding error, it is roughly seven thousand dollars, and it rises as the base premium does.

The second is the part nobody budgets for: during those seven years you paid full retail for every prescription you did have. People rarely reach 72 having filled nothing. They fill a course of something expensive after a fall, or a short run of a brand-name drug after a diagnosis, and pay the cash price because there was no plan to run it through. That is the cost that does not show up in the comparison, because it never arrives as a bill labelled “penalty.”

What actually protects you: creditable coverage

The penalty is not charged for going without a Part D plan. It is charged for going without creditable prescription drug coverage — which Medicare defines as coverage expected to pay, on average, at least as much as Medicare drug coverage does. If you have that, you are not accruing anything, and you can enrol later with no penalty at all.

Source: Medicare.gov, "Creditable prescription drug coverage." Medicare states directly that samples, discount cards, free clinics and drug discount websites are not drug coverage.

That right-hand column is the one that catches people. A discount app that gets a generic down to a few dollars feels like coverage — it functions like coverage at the counter — and it protects you from precisely nothing where the penalty is concerned. I have sat with more than one household in Peoria who had gone years believing they were fine because their pharmacy card “always got the price down.”

Two more things about creditable coverage are worth knowing before September.

Your plan has to tell you. Medicare requires that whoever provides your existing drug coverage tells you whether it is creditable, and they send that notice each year. Keep those notices in the same folder as your Medicare card. They are the only proof you will have if a penalty is ever assessed in error.

And there is a form that decides it. When you join a Medicare drug plan or an Advantage plan, the plan may send you a letter asking whether you had creditable drug coverage before. Medicare is blunt about what happens next: if you do not return the form by the deadline in the letter, the plan has no way to know you were covered, and you will be charged a late enrollment penalty. It arrives looking like every other envelope from the insurer. It is not.

Why the $2,100 cap changed this question

There is a newer reason to hold a drug plan you do not think you need, and it has nothing to do with penalties.

Part D now has a hard annual out-of-pocket cap of $2,100 on covered drugs. Once you have paid that much in a calendar year, your covered prescriptions cost you nothing for the rest of the year. There is no equivalent for someone without a plan — the retail price of a specialty drug simply keeps running.

That turns a drug plan into something closer to catastrophic insurance, which is exactly the framing that makes sense for a healthy 66-year-old. You are not buying it to save four dollars on a generic. You are buying it so that the year something serious happens, your drug exposure has a ceiling. A plan may also charge a deductible of up to $615 before coverage begins, so the shape of the plan matters — but the ceiling above it is set by law.

For the mechanics of formularies, tiers and pharmacy networks, Part D explained is the long version, and why drug costs jump in January covers what changes at the turn of the year.

The north Peoria version of this question

Three local patterns show up often enough here that they are worth naming.

Recent arrivals who let coverage lapse in the move. North of the Loop 303 — 85383, Vistancia, Trilogy, Blackstone — a large share of households arrived from somewhere else in the last few years. Coverage bought in another state does not always survive the move intact, and the gap between dropping one thing and setting up another is where 63 days quietly passes. The clock does not care that the lapse was administrative.

Seasonal residents. Westbrook Village and the 55-plus communities hold a lot of people who spend part of the year out of state. Part D travels better than most people expect — plans generally cover you at network pharmacies nationwide — but a plan’s preferred pharmacy list is where the money is, and a chain that is preferred in Peoria may not be preferred wherever you summer. That is a plan-selection question, not a reason to skip coverage.

Retirees still on a former employer’s drug plan. This is the affluent-household version, and it is the one where the mistake costs the most. Retiree drug coverage is often creditable, and while it is, you are protected. The risk is what happens when the former employer changes the benefit — which they can do, usually with a notice that arrives in the same week as everything else. If the coverage stops being creditable and you do not act, the 63-day clock starts without any announcement that it has.

And the local caveat that applies to every plan comparison in this city: ZIPs along the Peoria–Glendale–Sun City seam sit close enough together that neighbours a mile apart can be offered different plan line-ups and different preferred pharmacies. Price your own ZIP rather than borrowing a friend’s answer — the Peoria service-area page has the local picture, and if you sit near the boundary, the Glendale page is worth a read too.

What to do between now and December 7

If you have no drug coverage today and no creditable coverage protecting you, the fix is a calendar exercise, not a complicated one.

1. This week — establish whether you are actually uncovered. If you have coverage through a former employer, TRICARE, or the VA, find this year’s notice and check the word “creditable.” If you cannot find it, ask the benefits administrator for it in writing.
2. Late September — read what arrives. If you already have a Medicare plan, your Annual Notice of Change is due by September 30 and tells you what your drug coverage does on January 1. The open enrollment walkthrough covers what to look for.
3. October 15 to December 7 — enrol. Compare stand-alone drug plans against the prescriptions you actually take, including the ones you take occasionally. Bring the bottles: dose and manufacturer both affect the price.
4. Return the creditable-coverage form. If the new plan sends the letter asking about prior coverage, answer it before the deadline. This is the single easiest penalty to avoid and the most annoying one to reverse.
5. If a penalty is assessed and you had coverage, dispute it. The notices you kept are the evidence.

Higher income adds a separate layer, and it applies to drug coverage as well as to Part B: above $109,000 for a single filer and $218,000 filing jointly, based on your 2024 tax return, IRMAA adds a surcharge to both. If a one-off event pushed you over — a home sale, a Roth conversion, the year you retired — that is appealable on Form SSA-44, and worth raising with your tax advisor. You can see where your income lands in about a minute, and the full picture of what Medicare costs puts the drug plan next to everything else.

The honest summary

If you take nothing, a drug plan will feel like money for nothing for as long as that stays true — and for some people it stays true for years. Nobody enjoys paying for it.

But the comparison is not “premium versus no premium.” It is “a modest premium now” against “a permanent penalty plus retail drug prices in the years you turn out to need them,” and I have never seen the second win over a full retirement. That is why the penalty rules are worth twenty minutes even for somebody in perfect health.

If you would rather someone else checked

Working out whether your existing coverage is creditable, and what a minimal drug plan costs in your own ZIP, is about a twenty-minute conversation. There is no charge for it, and if the answer is that you are already protected and should do nothing, that is a fine outcome — I would rather tell you that than sell you something.

The office is in Anthem, roughly 25 minutes from north Peoria out the Carefree Highway and down Lake Pleasant Parkway, and most of this gets done by phone anyway. Call (602) 844-6002 or book a time — and if you call or text, that is your consent for me to reply the same way.

Bring the notice from your current coverage, if you have one. It answers half the question before we start.