Medicare Part D eligibility is dependent on Medicare Part A and Part B enrollment. To be eligible for Medicare Part D, you must first enroll in Medicare Part A, Medicare Part B, or both. Medicare Part D provides beneficiaries with coverage for the cost of prescription drugs. For many, prescription medications are an essential element in maintaining a healthy lifestyle.
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The cost of medications can put a strain on finances. To alleviate this, Medicare Part D prescription drug plans help reduce the price of these drugs for beneficiaries.
Who is Eligible for Medicare Part D?
Not everyone on Medicare is eligible for Medicare Part D coverage. To enroll in a Medicare Part D plan, you must first meet certain requirements. Medicare Part D eligibility requires you to first be eligible for Medicare.
If you are dually-eligible for Medicare and Medicaid, you can enroll in Medicare Part D. However, enrolling in a Medicare Advantage plan that offers prescription drug coverage makes you ineligible for a stand-alone Medicare Part D plan.
Medicare Part D Plan Combinations
- Medicare Part A + Medicare Part D
- Medicare Part B + Medicare Part D
- Medicare Part A + Medicare Part B + Medicare Part D
- Medicare Part A + Medicare Part B + Medicaid + Medicare Part D
- Medicare Part A + Medicare Part B + Medigap + Medicare Part D
If you need help covering your monthly Medicare Part D premiums, programs like Extra Help offer financial assistance to those who qualify.
When to Enroll in Medicare Part D
When you first become eligible for Medicare, you get an Initial Enrollment Period. This is a seven-month timeframe for a new beneficiary to enroll in Original Medicare and Medicare Part D.
If you decide not to enroll in Medicare Part D during your Initial Enrollment Period and instead delay coverage, it is essential to have creditable drug coverage in place. If you delay Medicare Part D enrollment and do not have creditable drug coverage, you will be subject to the Medicare Part D late enrollment penalty when you do enroll in the future.
Each year, the Medicare Annual Enrollment Period runs from October 15 to December 7. This is the time for Medicare Part D beneficiaries to make changes to their prescription drug plan elections. Also during this time, those who delayed Medicare Part D without creditable coverage can enroll in a plan. The final change you make during the Annual Enrollment Period will take effect January 1 of the following year.
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Lastly, if you delayed Medicare Part D but had creditable drug coverage in place since becoming eligible for Medicare, you will get a Special Enrollment Period when you lose drug coverage.
Delaying Medicare Part D Coverage
If you delay Medicare Part D without creditable drug coverage, you’ll incur a Medicare Part D Late Enrollment Penalty in addition to your Medicare Part D premium each month.
As we grow older, our chances of needing prescriptions will often increase. If you have no creditable prescription drug coverage, you should enroll when you’re first eligible.
For many seniors, taking prescription drugs on a regular basis is not optional. Patients who have regular medication needs should be sure to enroll as soon as their Medicare Part D eligibility begins.
Unexpected or not, the cost of medications can be financially exhausting. Medicare Part D plans allow you to pay less for the same quality medications.
FAQs
How to Get Help Determining Medicare Part D Eligibility
If you qualify for Medicare Part D, you could enroll in a drug plan that covers your prescription costs. These plans can help lower your prescription drug expenses substantially.
For coverage options, call one of our licensed Medicare agents today at the number above! Our team is happy to answer your questions while pointing you in the best direction for your health care needs.
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Sources:
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- How To Get Prescription Drug Coverage, Medicare. Accessed February 2022.
https://www.medicare.gov/drug-coverage-part-d/how-to-get-prescription-drug-coverage - Medicare Prescription Drug Eligibility and Enrollment, CMS . Accessed February 2022.
https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicarePresDrugEligEnrol
Mom ha a Medicare Replacement Program through Empire Bluecross/Blueshield and the Steamfitters Union Local 638 in NYC. Does she still have Medicare Part D coverage?
Thanks for your time
Hi Brian! Some Medicare Advantage plans do come with prescription drug coverage, they are known as MAPDs. You would need to contact the carrier to see if you have drug coverage and what the formulary is.