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Medicare Part D Eligibility Requirements


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.

Tip: Medicare Plan D and Part D aren’t the same things.

Delaying Part D When Eligible

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 Part D. 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.

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.

FAQs

Can you have both Part C & Part D?
No, you can’t have both. If you enroll in Part D while you have Part C, you’ll lose your medical coverage from Medicare Advantage and return to Medicare.
Can you have both Part D and Medigap?
Yes, in fact, if you have Medigap you’ll need to buy a Part D plan
Do I need Medicare Part D if I have supplemental insurance?
If you have a Medigap plan for supplemental insurance, yes you do need Part D. But if you have a Medicare Advantage plan that includes Part D, you can’t have a separate Part D plan.

How to Get Help Determining Medicare Part D Eligibility

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 and enroll when you enroll in 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.

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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. Hi Faith – it is currently the Medicare Annual Enrollment Period. Through December 7, you can explore different Medicare Advantage plans or drop your Medicare Advantage plan and pick up a Part D prescription drug plan that includes your prescriptions and dosages for more reasonable prices.

  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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