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.
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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.
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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.
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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
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!
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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.
- How To Get Prescription Drug Coverage, Medicare. Accessed February 2022.
https://www.medicare.gov/drug-coverage-part-d/how-to-get-prescription-drug-coverage - Medicare Prescription Drug Eligibility and Enrollment, CMS . Accessed February 2022.
https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicarePresDrugEligEnrol
I signed up for silver script but my levothryroxin costs 122 a month. Is there a cheap plan that pays for it?
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.
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
Hi Brian! Some Medicare Advantage plans do come with prescription drug coverage. This is known as a MAPD. You would need to contact the carrier to see if you have drug coverage and what the formulary is.