Medicare Part D Drug Benefit Eligibility

Fact Checked
Expert reviewed by: Caren Lampitoc
Published: 2/26/2021


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Caren Lampitoc
Medicare Consultant
Caren Lampitoc
Medicare Consultant

Caren Lampitoc is an educator and Medicare consultant for Medicare Risk Adjustments and has over 25 years of experience working in the field of Medicine as a surgical coder, educator and consultant.

Medicare Part D is Medicare’s prescription drug coverage program. There are specific rules about what prescription drugs Medicare Part D will cover and how much of each medication it will cover, which can vary based on your specific Medicare plan and situation. Learn the rules on who is eligible for Medicare Part D, when you should enroll in Part D to maximize your benefits, and who does not qualify for Medicare Part D.

Who is Eligible for Medicare Part D Drug Benefits?

Part D prescription drug coverage is offered through Original Medicare, so anyone who is eligible for Medicare is also eligible for Medicare Part D drug benefits. According to HHS.gov, everyone with Medicare, no matter your income level, health status, or prescription drug usage, has access to prescription drug coverage. You are eligible for Medicare Part D drug benefits if you meet the qualifications for Medicare eligibility, which are:

  • You are age 65 or older
  • You have disabilities
  • You have end-stage renal disease

You can enroll in Medicare Part D as soon as you are eligible for Medicare and even if you have other prescription drug coverage. In fact, you will want to enroll in Medicare Part D as soon as you are able to avoid a late enrollment penalty. There are specific enrollment periods for Medicare Part D based on when you join Medicare and for certain extenuating circumstances, but essentially, you will want to join Part D as soon as you are eligible.

When Should I Enroll in Medicare Part D to be Eligible For Benefits?

Medicare Part D is an optional part of Medicare. Even if you do not currently need prescription drug coverage,, it is recommended that you still enroll in Part D as soon as you are eligible, so you’re covered when and if you do require prescription medication. If you opt to delay enrolling in Medicare Part D because you don’t currently require prescription drug coverage or have another health insurance plan that you’re using instead of Medicare, you will most likely pay a late enrollment penalty if you do enroll later.

The late enrollment penalty isn’t just a one-time cost. It is a permanent cost that will be added to your Medicare Part D premium for as long as you use Medicare. You may have to pay the late enrollment penalty if there is a lapse in your prescription drug coverage for 63 days or more past your Initial Enrollment period. That includes if you simply opt out of the coverage when you initially enroll in Medicare, or if you had another insurance plan you were using for prescription medication that runs out and leaves you without creditable prescription drug coverage for 63 days or more.

The exact amount you will pay for a late enrollment penalty will vary based on the number of months you went without drug coverage and a national yearly based premium, which usually changes every year. In general, to calculate a late enrollment penalty, Medicare will multiply 1% of the current national base beneficiary premium–which again, can change every year. It is $33.06 in 2021.

For example:, if you went 10 months without coverage and enrolled late, your penalty would look like: $33.06 x .10 (1% multiplied by 10) = $3.30.

Who Isn’t Eligible for Medicare Part D?

Everyone who is eligible for Medicare is eligible for Part D prescription drug coverage. However, you can also choose to receive Medicare prescription drug coverage through a Medicare Advantage Plan, or Medicare Part C.

You cannot have both a Medicare Advantage plan (Part C) with drug coverage and Part D (drug coverage) at the same time. If you have Part D and decide to join a Medicare Advantage plan with drug coverage, your Part D coverage will stop as soon as your new coverage in the Medicare Advantage plan begins. If you have a Medicare Advantage plan with drug coverage and decide to join a Part D plan, you will be disenrolled from the Medicare Advantage plan and returned to Original Medicare.

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