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To get Medicare coverage for prescription medications, you need to enroll in Medicare Part D. Unlike Medicare Parts A and B, Medicare Part D is a voluntary plan, so you will not be automatically enrolled when you turn 65 years old.
Medicare beneficiaries who want to get Part D coverage need to sign up for a plan from a Medicare-approved private insurer. However, there are eligibility requirements that apply. Generally, every Medicare beneficiary has the right to enroll in Medicare Part D and eligibility requirements are the same as for Original Medicare. The only additional requirement is that you must live in your desired plan’s service area to be able to apply for it.
Who is eligible for Medicare Part D?
Any Medicare beneficiary with Original Medicare is eligible for Medicare Part D prescription coverage. You can enroll for Medicare Part D when you first become eligible for Medicare which is the 7-month period that runs from three months before your 65th birthday to the three months following your 65th birthday. You can also enroll during Annual Open Enrollment from October 15th to December 7th each year or during Medicare Advantage Open Enrollment Period.
Read more about enrollment periods for Medicare Part D here.
If you have a Medicare supplement plan (Medigap) to help cover your Part A and Part B out-of-pocket costs, you can still enroll in a Medicare Part D plan. Medigap plans do not offer coverage for prescription drugs, so it is recommended that you enroll in Part D even if you have a supplement plan to avoid incurring high out-of-pocket costs for your prescription needs.
If you are enrolled in a Medicare Advantage plan (also called Medicare Part C) instead of Original Medicare, you can get prescription drug coverage under Medicare Advantage benefits. This means you are not eligible to enroll in a stand-alone Medicare Part D plan. However, note that some Medicare Advantage plans do not include drug coverage, so you need to check before you enroll.
Medicare beneficiaries who have creditable drug coverage from an employer, union, or private insurer do not have to enroll in Medicare Part D. However, you will need to provide proof of creditable coverage to avoid a Part D late enrollment penalty when you finally decide to enroll.
Medicare Part D eligibility requirements for 2024
Eligibility by age (seniors aged 65 or older)
If you are an older American who has attained the age of 65 years, you will automatically become eligible to enroll for Original Medicare, which includes Part A and Part B. Once you become eligible for Original Medicare, you are also eligible for Medicare Part D.
It is recommended that you sign up for Part D Medicare when you first become eligible, at 65 years, to avoid incurring a late enrollment penalty.
Eligibility due to a disability or illness
Disabled Americans who qualify for Original Medicare are also eligible for Medicare Part D. This means that even if you are not yet 65 years old, but receive Social Security or Railroad Retirement Disability benefits, you are eligible to enroll in a Medicare Part D plan. Keep in mind that you must first be enrolled in Part A and/or B before enrolling in a Medicare Part D plan.
Some of the qualifying illnesses that may qualify you for Medicare Part include:
· End Stage Renal Disease (ESRD)
· Lou Gehrig’s disease (ALS)
Location
The only additional requirement for a Medicare Part D eligibility that is not in place for Original Medicare is the location of a beneficiary. You must permanently reside in your desired plan’s service area to be able to enroll in it. Homeless people can use the address where they receive mail, PO boxes, shelter or hospital addresses.
Questions about Medicare?
Shoot us an email at medicare@hihella.com.
Article updated on December 28, 2023.
