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Medicare Part D Eligibility Requirements


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

Can you have both Medicare Part C and Part D?
Most of the time, your Medicare Advantage plan includes prescription drug coverage, so in that case, you can’t have both. However, if you have a Medicare Advantage plan in the form of a Medical Savings Account (MSA) or Private Fee for Service (PFFS) that lacks drug coverage, you may enroll in a Medicare Part D plan.
Can you have both Medicare Part D and Medigap?
Yes – in fact, if you have Medigap you’ll need to buy a Medicare Part D plan to receive prescription drug coverage.
Do I need Medicare Part D if I have supplemental insurance?
If you have a Medigap plan for supplemental insurance, you’ll need a Medicare Part D plan for drug coverage. But if you have a Medicare Advantage plan that includes drug coverage, you cannot have a separate Medicare Part D plan.

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:

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

  1. How To Get Prescription Drug Coverage, Medicare. Accessed February 2022.
    https://www.medicare.gov/drug-coverage-part-d/how-to-get-prescription-drug-coverage
  2. Medicare Prescription Drug Eligibility and Enrollment, CMS . Accessed February 2022.
    https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicarePresDrugEligEnrol

Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

4 thoughts on “Medicare Part D Eligibility Requirements

  1. 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

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