Medicare Part D Eligibility

Summary: To meet Medicare Part D eligibility requirements, you must be enrolled in Medicare Part A and/or Medicare Part B. For many, this means you will become eligible for Medicare Part D once you turn 65. However, some individuals may qualify for drug coverage earlier if they get Medicare under the age of 65 due to a disability. In this article, we’ll explain how Medicare Part D eligibility works with different groups of people and provide an easy-to-use checklist to see if you meet the eligibility criteria for Part D. Estimated Read Time: 5 min

Who is Eligible for Medicare Part D

Most people become eligible for Medicare Part D when they turn 65 and enroll in Medicare Part A and/or Medicare Part B. Some people may qualify under the age of 65 if they qualify for Medicare due to having a disability, ALS (Lou Gehrig’s disease), or End-Stage Renal Disease. Regardless of when you become eligible for Medicare Part D, you should keep these other requirements in mind:

To be eligible for Medicare Part D, you must have at least one part of Original Medicare. This means you can have only Medicare Part A, only Medicare Part B, or you can have both and still qualify for Part D drug coverage. When you enroll in Medicare Part A and/or Part B, you will receive your Medicare card through the mail. This card will include your coverage start date as well as your Medicare Beneficiary Identifier number. You will need to provide your Identifier number when signing up for a plan.

Medicare Part D Prescription Drug plans are offered by private insurance carriers. So, to be eligible for a Medicare Part D plan, you must live within that plan’s service area. Though not all plans are available in all locations, most people will still have a variety of plans available where they live to choose from.

Medicare Part D Eligibility for Those 65 and Older

If you are 65 years of age or older and a U.S. citizen (or permanent resident), then you will become eligible for Medicare Part D as soon as you enroll in Medicare Part A and/or Medicare Part B. If you are automatically enrolled in Medicare Part A and Part B because you are already receiving retirement benefits when you turn 65, you will be eligible to enroll in a Medicare Part D plan at any time during your Initial Enrollment Period (after receiving your Medicare card).

Medicare Part D Eligibility if You Receive Disability

Individuals who are under the age of 65 but have been receiving disability benefits (from Social Security or the Railroad Retirement Board) for more than 24 months will be eligible for Medicare Part D. If you qualify for Medicare due to disability, you will automatically be enrolled in Medicare Part A and Part B once you become eligible. Once you receive your Medicare card, you can enroll in a Medicare Part D plan.

Medicare Part D Eligibility for Individuals on Medicaid

If you are receiving Medicaid, you will become eligible for Medicare Part D as soon as you enroll in Medicare. Since there are several ways to qualify for Medicaid, your Medicare eligibility date will depend on your individual situation. If you receive full Medicaid benefits, you will automatically qualify for the Medicare Part D low-income subsidy called Extra Help. Individuals who are eligible for Medicare Part D, and qualify for Extra Help, may be automatically enrolled in a Part D plan as soon as they become eligible.

Medicare Part D Eligibility Checklist: Do I Qualify for Part D?

Are you eligible to enroll in a Medicare Part D plan? Below, we’ve broken down each of the eligibility requirements for Medicare Part D to make it easier to determine whether you qualify.

Age Requirements for Medicare Part D: (you must meet one of the following requirements)

• You are age 65 or older, or are turning 65 in three months
• You are under the age of 65 and have been receiving disability benefits for 24 months or more
• You are under the age of 65 and have been diagnosed with ALS or ESRD

Medicare Coverage Requirements for Part D: (you must meet one of the following requirements)

• You have Medicare Part A
• You have Medicare Part B
• You have both Medicare Part A and Medicare Part B
• Your Medicare Part A and/or Part B coverage has not started, but you have enrolled and received your Medicare card*

*This can happen when you enroll in Medicare Part A and/or Part B during the first three months of your Initial Enrollment Period. Your Medicare Part A and/or Part B coverage will not begin until your birthday month. In this case, you are still eligible to sign up for a Medicare Part D plan, however your drug coverage won’t kick in until your Part A and/or Part B coverage begins. You will need your Medicare Beneficiary Identifier number from your Medicare card to enroll in Part D.

Other Eligibility Requirements for Medicare Part D:

• You must be a U.S. citizen or permanent resident of the U.S. for at least 5 years
• You must live within the service area of the Medicare Part D plan you wish to enroll in

Learn More About Eligibility and Medicare Drug Coverage

Enrolling in Medicare Part D as soon as you become eligible can help you avoid the Part D late enrollment penalty and help ensure you don’t have a gap in coverage. If you’re eligible for Medicare Part D, you can enroll in a drug plan anytime during a valid enrollment period, such as your Initial Enrollment Period or the Annual Enrollment Period.

If you’re not yet eligible for Medicare Part D, but will become eligible soon, you can prepare for enrollment by comparing Medicare Part D carriers and plans. Remember: you can start researching plans at any time, but you won’t be able to purchase a policy until you meet the eligibility requirements above and enroll in Part A and/or Part B.

You can learn more about Medicare Part D enrollment periods, carriers, and what coverage plans provide by checking out our resources below. If you have questions regarding Medicare Part D eligibility and would like to speak with a licensed agent, you can do so by calling the number above. Our team of licensed agents can help you with any questions you may have regarding Medicare drug coverage.

Sources

Medicare Prescription Drug Eligibility and Enrollment, Centers for Medicare & Medicaid Services. Accessed February 2024

https://www.cms.gov/medicare/enrollment-renewal/part-d-plans

How to Get Prescription Drug Coverage, Medicare.org. Accessed February 2024

https://www.medicare.gov/drug-coverage-part-d/how-to-get-prescription-drug-coverage