Understanding Your Medicare Part D Eligibility

Understanding Your Medicare Part D Eligibility

  admin       Jun 02, 2023

Understanding Your Medicare Part D Eligibility

Reaching retirement age can be an exciting stage of life but it can be overwhelming to navigate changes in your insurance coverage. Medicare is the government health insurance program that provides healthcare coverage for individuals 65 and older. Medicare Part A and Part B provide hospital and medical insurance, but what about drug coverage? Medicare Part D is the prescription drug benefit component of Medicare. Based on the individual plan, it covers a variety of prescription drugs, as well as some over-the-counter medications.

Are you Eligible?

To find out if you are eligible for Medicare Part D, you first need to determine if you are eligible for Original Medicare (Parts A and B).

You are eligible for Original Medicare if any of the following qualifications are met:

• You are age 65 or older.
• You have a qualifying disability.
• You have end-stage renal disease (permanent kidney failure requiring dialysis treatment or a kidney transplant)

Once you become eligible and enroll in Medicare Part A and/or Part B, you become eligible for the Medicare drug benefit (Part D).

Worried about being denied coverage because you have high blood pressure, take multiple medications daily, or are a smoker? Like Original Medicare, Medicare Part D is available regardless of pre-existing or future health conditions.

Just because you are eligible for a Medicare Prescription Drug Plan, does not mean you are required to have one. However, it is important to consider at the time you first become eligible for Medicare to avoid a lifetime late enrollment penalty and gaps in coverage in the future.

What If You Already Have Other Drug Coverage?

Whether you receive prescription drug coverage from Veterans Affairs Benefits, TRICARE for Life, Federal Employee Health Benefits, or other job-based or retiree plans; The Medicare Modernization Act (MMA) requires these entities to notify Medicare eligible policyholders if their prescription drug coverage is creditable coverage before October 15th each year. Creditable coverage simply means that the coverage is expected to pay the same amount as the standard Medicare prescription drug coverage.

If you are unsure if your current prescription drug coverage is considered creditable, reach out to your benefits representative to find out. It is important to do this as soon as possible because if you go more than 63 days (about 2 months) without creditable coverage before signing up for a Medicare Part D Plan, you will be charged a lifetime penalty.

But do not worry — if your creditable coverage ends or changes in the future you will receive a two-month Special Enrollment Period (SEP) to enroll in a Part D plan, penalty free.

Receiving Part-D Benefits

If you do not have other Creditable Coverage, you have two options to receive prescription drug benefits:

• If you have Original Medicare, Part A or Part B, you can enroll in a stand-alone Part D plan.
• Most Medicare Advantage Plans – which include both Medicare Part A and Part B – also offer prescription drug coverage.

Now that you have determined you are eligible for Medicare Part D, there is one more eligibility requirement you need to consider.

One Last Thing to Consider

Once you have enrolled in Original Medicare or a Medicare Advantage Plan, there is one more eligibility requirement you must meet, depending on which plan you choose. Each prescription drug plan requires that you live in that plan’s service area.

If you move to another service area during your plan year, you will receive a Special Enrollment Period (SEP) and can enroll in a new plan available in your new region.

While different plans may cover different prescriptions or may include additional benefits, Medicare requires all plans to provide the same basic level of drug coverage.

Just because pronouncing the name of your prescriptions is challenging does not mean that navigating Medicare Part D coverage should be too. Plan Advisors is here to help you find the plan that works best for you. Reach out to an agent to get started today.