Close  

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.

Find Medicare Plans in 3 Easy Steps

We can help find the right Medicare plans for you today

What is Medicare Part D?

Medicare Part D provides beneficiaries with coverage for the cost of prescription drugs. For many, prescription medications are essential in maintaining a healthy lifestyle. Medicare Part D is provided by private insurance companies and regulated by Medicare. To receive the most comprehensive Medicare Part D coverage, it is important to review all the plan options and make a decision based on your needs as an individual.

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.

How Can I Be Eligible for Medicare Part D?

Not everyone on Medicare is eligible for Medicare Part D coverage.To be eligible for Medicare Part D plan coverage, you must first meet specific requirements to enroll in a Medicare Part D plan. Medicare Part D eligibility requires you first to enroll in Original Medicare.

You may also find that you are dual eligible for Medicare and Medicaid. In this case, you can enroll in Medicare Part D.

However, if you are enrolled in a Medicare Advantage plan that offers prescription drug coverage, you will be ineligible to enroll in a stand-alone Medicare Part D plan.

Types of Medicare Plan Combinations for Medicare Part D Eligibility

To be eligible for Medicare part D you are only required to be enrolled in ONE part of Original Medicare. Below lists all of the possible plan combinations you can have that involve Medicare Part D.

  • Medicare Part A + Medicare Part D – With this combination, you will receive inpatient hospital coverage and drug coverage.
  • Medicare Part B + Medicare Part D – With this combination, you will receive outpatient doctors coverage and drug coverage.
  • Medicare Part A + Medicare Part B + Medicare Part D – this combination allows you to have inpatient coverage, outpatient coverage and drug coverage
  • Medicare Part A + Medicare Part B + Medicaid + Medicare Part D – This combination allows you to have inpatient coverage, outpatient coverage, drug coverage, and additional help for out-of-pocket costs funded by your state
  • Medicare Part A + Medicare Part B + Medicare Supplement + Medicare Part D – This combination is the most ideal combination and provides the most comprehensive coverage
  • Medicare Part C + Medicare Part D – If your Medicare Part C plan does not offer drug coverage, this combination allows you to have healthcare and drug expenses covered
  • You CAN NOT enroll in a Medicare Advantage Prescription Drug plan and a standalone Medicare Part D plan because you cannot have two different types of prescription drug coverage through Medicare

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.

Find Medicare Plans in 3 Easy Steps

We can help find the right Medicare plans for you today

If you decide not to enroll in Medicare Part D during your Initial Enrollment Period and 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.

The Medicare Annual Enrollment Period runs from October 15 to December 7 each year. This is the time for Medicare Part D beneficiaries to change 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 on January 1 of the following year.

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.

Take Bob for example, Bob had never taken prescription drugs in his life. So, he did not enroll in Medicare Part D. However, one unexpected prescription could have financially devastated him.

Find Medicare Plans in 3 Easy Steps

We can help find the right Medicare plans for you today

Tips for Choosing the Best Medicare Part D Plan

When it comes to enrolling in drug coverage, all Medicare Part D plans are offered through private insurance companies. Additionally, Medicare Part D plan availability is different from state to state.

To find the right Medicare Part D prescription drug coverage for you, you must understand your coverage and budget needs. You can review the different plan types and narrow down the best plans for you.

Once you are eligible for Medicare Part D, you will want to choose a prescription drug plan that has high ratings as well as low copayments for the drugs you are already prescribed. So, it is important to review the plans formulary before enrolling in coverage.

Keep in mind, the best Medicare Part D plan for you may not be the best plan for someone else and vice versa. Medicare is an individualized healthcare plan that is designed to put your needs first.

Medicare Part D Eligibility FAQs

Can you have both Medicare Part C and Part D?
Most of the time, your Medicare Advantage plan (Medicare Part C) 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 be denied Medicare Part D?
You cannot be denied enrollment to a Medicare Part D plan. These plans are guaranteed issue as long as you are within a valid enrollment period. Pre-existing conditions will never affect Part D enrollment.
Can you have both Medicare Part D and Medicare Supplement plan?
Yes – in fact, if you have Medicare Supplement plan you’ll need to buy a Medicare Part D plan to receive prescription drug coverage.
Is Medicare Part D based on income?
Medicare Part D eligibility is not based on income. However, the premium you pay is based on your Monthly Adjusted Gross Income from your tax returns two years prior to the current year. This means, higher earners may have an additional fee on top of their Part D premiums.
Does everyone get Medicare Part D?
Medicare Part D is not mandatory. However, if you wish to have prescription drug coverage, you will need to enroll in a Medicare Part D plan. Additionally, if you delay Medicare Part D without creditable coverage, you may be responsible for paying the Medicare Part D late enrollment penalty when you decide to get one.
Do I need Medicare Part D if I have supplemental insurance?
If you have a Medicare Supplement (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 Enroll in Medicare Part D

If you are eligible 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.

To understand if you are eligible for Medicare Part D plan coverage, 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.

When you use our agents' services, they'll compare plans and provide free quotes for you. If you can’t call us today, fill out an online rate form to start shopping for your best policy!

Enter ZIP Code

Enter ZIP Code

Enter your ZIP code to pull plan options available in your area.

Compare Plans

Compare Plans

Select which Medicare plans you would like to compare in your area.

Get Quote

Get Quote

Compare rates side by side with plans & carriers available in your area.

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

    Comment

    Your email address will not be published.