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Who Qualifies for a Medicare Part D Prescription Drug Plan?


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If you’re eligible for Medicare, you generally also qualify for prescription drug coverage under the Medicare Part D program.

Who qualifies for Medicare Part D: how can you get Part D coverage

You don’t automatically receive Medicare prescription drug coverage, nor are you required to sign up for it. However, it’s something you might want to think about.

Unless you have prescription drug coverage that is at least as good as the coverage Medicare Part D provides (called creditable coverage), you could face a Part D penalty later. That is, if you don’t sign up for Part D prescription drug coverage during your Initial Enrollment Period, and then decide you want that coverage later – a penalty could be attached to your monthly Part D premium. Learn more about Medicare late enrollment penalties.

Those who qualify for Medicare Part D must have Medicare Part A and/or Part B

You may have the choice of two types of Medicare plans—a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan. Your Part D coverage choices are generally:

  • A stand-alone Medicare Part D Prescription Drug Plan, if you have Medicare Part A or Part B or both.
  • Medicare Advantage Prescription Drug plan, if you have both Medicare Part A and Part B. If you choose a Medicare Advantage Prescription Drug plan, you get your Part A and Part B coverage through the plan.

Those who qualify for Medicare Part D must live in the plan’s service area

No matter what type of Medicare Prescription Drug Plan you have (or you want to sign up for), you must reside in the plan’s service area. It’s easy to find plans available where you live – just enter your zip code and click on the button on this page.

Those who qualify for Medicare Part D can sign up at certain times of the year

If you qualify for Medicare Part D, there are specific times of the year when you can enroll.

Initial Enrollment Period. You can typically sign up for a Medicare Part D Prescription Drug Plan during your Medicare Initial Enrollment Period. For most people, this is the seven-month period that begins 3 months before the month you meet Medicare eligibility requirements, includes that month, and ends 3 months later. During the Initial Enrollment Period, you may enroll in a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan.

Annual Enrollment Period (AEP). Also known as Fall Open Enrollment, the AEP occurs from October 15th to December 7th every year. At this time you can enroll in a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan. You might be able to make other coverage changes during this time.

Medicare Advantage Open Enrollment Period. This period goes from January 1 – March 31 every year (starting in 2019). This is a one-time chance to enroll in a Medicare Advantage Prescription Drug plan. You can also disenroll from a Medicare Advantage plan, return to Original Medicare, and enroll in a stand-alone Medicare Part D Prescription Drug Plan.

Special Election Period (SEP). You can enroll or make changes to your Medicare prescription drug coverage when certain events happen in your life. Some examples of these events are: you move outside your plan’s service area; you involuntarily lose other creditable prescription drug coverage; you’re eligible for both Medicare and Medicaid; or you qualify for Extra Help to help pay for Medicare prescription drug coverage. These are just examples.

If you qualify for a SEP, it will start on a certain date and last for a certain length of time depending on how you qualify and when.

You can start comparing Medicare Prescription Drug Plans anytime you want. Just enter your zip code in the box on this page and click the button – it’s that simple! You can also call and speak with a licensed eHealth insurance agent.

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