Medicare Part D Eligibility

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Medicare Part D eligibility depends greatly on Part A enrollment. Medicare Part D provides extra coverage to beneficiaries for the costs of prescription drugs. For many, prescription medications are vital to maintaining a healthy lifestyle.

The costs of medications can drain finances, Medicare Part D prescription helps those who need assistance with medications.

Who is Eligible for Medicare Part D?

Not everyone is eligible for Part D coverage. To enroll in a Part D plan, you must first meet certain requirements. Part D eligibility requires you to have Original Medicare. If you don’t enroll when you’re first eligible and don’t have creditable coverage, you could face a late enrollment penalty. Let’s take a closer look at using an example.

A Closer Look

For example, Karen is getting close to her 65th birthday and is now eligible for Original Medicare coverage. Karen has left her group insurance from her employer and currently has no prescription drug coverage.

While Karen is starting the process of enrollment in Traditional Medicare, she discovers she’s eligible for Part D too. Karen is within her Initial Enrollment Period (IEP)and needs to enroll in a Part D plan.

Since Karen has no medical need for any regular medications, she decides to hold off on enrolling in a Part D prescription drug plan. Soon thereafter, Karen learns that she has Medical complications and will need to be put on multiple regular medications.

Now when she goes to enroll in a Part D prescription drug plan to help cover the unexpected costs of her medications. She discovers that her monthly Part D premium will have an additional fee each month.

Medicare may add a Part D Late Enrollment Penalty to your Part D premium each month you have Part D coverage. Unless you enroll in a Part D plan when you’re first eligible during your IEP.

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 Medicare Part D eligibility begins.

Unexpected or not, the cost of medications can be financially exhausting, Part D plans provide you with a much lower cost for the same quality of medications.

How does Medicaid work with Medicare Part D Plans?

Medicaid is another Federal and State government medical health insurance program. Medicaid provides coverage for individuals and families that have low incomes or limited resources. Not all will qualify for Medicaid coverage in addition to Medicare coverage.

Medicare beneficiaries with full Medicaid benefits are dually eligible. The majority of beneficiaries that are dual-eligible have very low income and significant health care needs.

Dual eligible beneficiaries now automatically have Medicare Part D prescription drug plan. Before Part D began, the Medicaid program provided drug coverage for dual-eligible beneficiaries.

If a dual eligible beneficiary wants to make changes to their plan or benefits, they may do so but only at certain times of the year.

For instance, we’ll say Karen is dual eligible and is unhappy with her current plan. Karen can join, change, or drop an Advantage Plan or Medicare Part D prescription drug plan. The change can be made only once during each of 3 periods; the first is from January-March, then from April to June, and finally from July to September.

However, Karen decides on October 7th that she wants to change her Part D plan. Luckily, she’ll have one more opportunity to make a change during the Annual Enrollment Period; from October 15-December 7. Changes will go in effect on January 1 the following year.

How to Apply for Extra Help with Medicare Part D?

If you qualify for Part D Extra Help eligibility, your options to enroll, change, or leave a plan are identical to dually eligible beneficiaries. If you’re no longer eligible for Extra Help for the following year, you will have a 3-month window to change plans. This period starts either the date you’re notified or when you’re no longer eligible; whichever happens first.

Beneficiaries that have Medicaid also get Extra Help covering the costs of prescriptions. However, Medicare beneficiaries without Medicaid may still be eligible for medication assistance.

Can you have both Part C & Part D?

Karen has a Medicare Part C; prescription drug coverage is part of many advantage plans. Being in a Medicare Advantage Plan, if she has a separate Medicare Prescription Drug plan, she would lose her Part C plan and return to Traditional Medicare.

Can you have both Part D and Medigap?

Karen has Medicare Part C, these plans replace Parts A, B, and D. Medigap, and Medicare Part C can’t work together. Medigap covers costs of coinsurance, copayments, and deductibles for healthcare services. However, Medigap doesn’t pay for them out of pocket expenses correlating to Advantage Plans.

How Can I Get Someone to Help me with Picking a Part D and Medigap Plan?

If you qualify for Medicare Part D, you could enroll in a Part D program that covers your prescription costs. These plans can help lower your prescription drug expenses substantially.

If you’re eligible for Medicare, consider a Part D prescription drug plan and enroll when you enroll in Original Medicare. Things can get confusing; we understand and we’re here to help.

Give one of our licensed Medicare agents a call today at the number listed above! Our team is happy to answer your questions while pointing you in the best direction for your health care needs.

When you use an agent, we compare plans and quotes for you. If you can’t call us today, fill out an online rate form, and find your best policy!

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