Medicare Part D is available to those on Original Medicare. If you are eligible for Medicare Part A and Part B, you are also eligible for Medicare Part D. Medicare Part D is the only part of Medicare to cover prescription drugs, so it is vital to enroll in Medicare Part D coverage when you become eligible.

Who is Eligible for Medicare Part D

There are several ways to become eligible for Medicare Part D. If you are over the age of 65, you automatically become eligible for Medicare Part D once you enroll in Medicare Part A or Medicare Part B.

If you are under 65, you become eligible for Medicare Part D if you receive Social Security Disability Income (SSDI) benefits for at least two years and enroll in Medicare Part A or Part B. If you are diagnosed with amyotrophic lateral sclerosis or end-stage renal disease, you automatically become eligible for Medicare Part A and Part B, which in turn grants you eligibility for Medicare Part D.

Keep in mind if you enroll in a Medicare Advantage plan with prescription drug benefits, you are no longer eligible for a stand-alone Medicare Part D plan.

Medicare Part D Enrollment Periods

To enroll in Medicare Part D, you must do so during an enrollment period. When you first become eligible for Medicare, you get an Initial Enrollment Period. This window is your first opportunity to enroll in a Medicare Part D plan. If you do not enroll within this timeframe, you could be subject to the Medicare Part D late enrollment penalty.

If you miss your Initial Enrollment Period, the next opportunity you will have to enroll in a Medicare Part D plan is the Annual Enrollment Period. During this time, you may enroll in a Medicare Part D plan or make changes to your existing plan for the upcoming year. Any changes you make during this time are active on January 1 of the following year.

Lastly, if you lose creditable coverage, experience a life-changing event, or your current plan goes bankrupt, you might be eligible for a Special Enrollment Period. Special Enrollment Periods allow a window for beneficiaries to enroll in a Medicare Part D plan outside of a typical enrollment period. Not everyone will become eligible for a Special Enrollment Period in their lifetime, so it is essential to do your research and make the best choice possible when you receive this opportunity.

Medicare Part D Late Enrollment

If you are eligible for Medicare Part D but have creditable prescription drug coverage, such as through an employer or spouse, you can delay Medicare Part D enrollment without penalty. However, if you delay Medicare Part D enrollment without creditable coverage, you must pay the Medicare Part D late enrollment penalty.

You will need to provide proof of creditable coverage to avoid the late enrollment penalty. If you are unsure whether your coverage is creditable, contact your local Social Security office.

Many Medicare beneficiaries need their daily prescription drugs to maintain their health. If you are lucky enough not to require prescription drugs, it is still wise to enroll in a Medicare Part D plan to avoid the penalty when you eventually decide to enroll.

On the other hand, if you delay benefits while you have creditable coverage, you will qualify for a Special Enrollment Period when that coverage ends. You will then have a 63-day window to enroll in the Medicare Part D plan of your choice.

Understand Medicare Part D Eligibility

Becoming educated about the Medicare Part D eligibility requirements is the first step in a successful future with Medicare. If you are unsure about your Medicare Part D eligibility, it is essential to speak with someone to verify your Medicare Part D status.

Working with an agent can help ensure you do not miss any steps of preparing for Medicare enrollment, including Medicare Part D. Medicare is an essential aspect of your health and wellbeing. Hence the importance of working with professionals who have your best interests in mind. 

Jagger Esch

Medicare Expert

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.