Speak with a Licensed Insurance Agent

Search
Close this search box.

Medicare Part D Eligibility

Summary: To be eligible for Medicare Part D you must be enrolled in at least one part of Original Medicare. Estimated Read Time: 3 min

Find Medicare Plans in 3 Easy Steps

Let us help you navigate your Medicare journey

Table of Contents:

  1. Who is Eligible for Medicare Part D?
  2. How Does One Become Eligible for Medicare Part D
  3. Eligibility Requirements for Medicare Part D
  4. How to Get Medicare Part D
  5. Medicare Part D Eligibility FAQs
  6. How to Apply for Medicare Part D

Who is Eligible for Medicare Part D?

Medicare Part D eligibility is straightforward and does not change based on your location.

To be eligible for Medicare Part D, you must be enrolled in Medicare Part A, Medicare Part B, or both.

Once you have enrolled in at least one part of Original Medicare, you are then eligible to enroll in a Medicare Part D plan. However, if you are enrolled in Medicare Part A and B, then decide to enroll in a Medicare Advantage plan, you may no longer be eligible for Medicare Part D enrollment. This is due to the availability of Medicare Advantage plans that do offer prescription drug coverage.

How Does One Become Eligible for Medicare Part D

Becoming eligible for Medicare Part D is simple and happens automatically once you receive your Red, White, and Blue Medicare card.

Once you receive your Medicare card, you can use your Medicare Beneficiary Identifier (MBI) number located on the card to complete your Medicare Part D application. Without your MBI, you will not be able to complete the Medicare Part D application.

Types of Medicare Plan Combinations for Medicare Part D Eligibility

  • 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 provides the most comprehensive coverage, leaving you with little to no out-of-pocket costs after Original Medicare pays its portion.
  • Medicare Part C + Medicare Part D – In some cases, if your Medicare Part C plan does not offer drug coverage, this combination could be available to you. However, not all plans allow you to enroll in a stand-alone drug plan.
  • 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.

Eligibility Requirements for Medicare Part D

To be eligible for Medicare Part D you must:

  • Be 65 years or older
    • If you are under 65, you must have received SSDI for 24 months or have a qualifying diagnosis.
  • Be a U.S. citizen or permanent resident for at least 5 years
  • Enroll in Medicare Part A or Medicare Part B

When you first become eligible for Medicare, you will receive 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

Let us help you navigate your Medicare journey

If you decide not to enroll in Medicare Part D during your Initial Enrollment Period and delay coverage, you have another opportunity to enroll during the Medicare Annual Enrollment Period in the fall.

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.

How to Get Medicare Part D

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 Part D 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?

In most cases, you cannot enroll in Medicare Part C and Medicare Part D at the same time. However, there are Medicare Advantage Prescription Drug plans that combine the two coverage types in one plan. 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.

Find Medicare Plans in 3 Easy Steps

Let us help you navigate your Medicare journey

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.

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 Apply for Medicare Part D

If you are eligible for Medicare Part D, you should apply for 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 and to compare options, call one of our licensed insurance agents today at the number above! Our team is happy to answer your questions while assisting you in your journey for health coverage.

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!

Find Medicare Plans in 3 Easy Steps

Let us help you navigate your Medicare journey

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/enrollment-renewal/part-d-plans
Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare guru serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Medicare Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

4 thoughts on "Medicare Part D Eligibility"

    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

Comment

Your email address will not be published. Required fields are marked *

X