Medicare is not just for Americans who are age 65 years and older. You may also be eligible for Medicare if you meet certain other criteria. And if you‘re eligible for Medicare, then you’re also eligible for Part D.

In this article, we’ll discuss the details you need to know about Medicare Part D eligibility.

If you’re eligible for Original Medicare (parts A and B), then you’re also eligible for Part D. To be eligible for Medicare, you must qualify in one of the following ways:

  • You or your spouse are at least 65 years old
  • You qualify for Social Security disability or Railroad Retirement Board benefits. The waiting period for Medicare is waived if you receive a diagnosis of amyotrophic lateral sclerosis (ALS). With this condition, you’re eligible for the first month you receive a disability payment.
  • You receive a diagnosis of end stage renal disease (ESRD) or kidney failure, and you need to have dialysis or a kidney transplant. Railroad employees with ESRD can contact Social Security to find out about eligibility for Medicare at 800-772-1213.
  • Children under age 20 years with ESRD can qualify if at least one parent is eligible for Social Security benefits.

There are rules for when you can and cannot enroll in a Medicare Part D plan. It’s important to learn the appropriate enrollment dates, when you may change your plan, and dates for dropping your coverage.

Here is an overview of important dates for adding or modifying your Medicare prescription drug coverage.

Medicare Part D enrollment

The open enrollment period occurs each year from October 15 to December 7. If you’re eligible, during this time, you may:

  • enroll in a plan that provides prescription coverage
  • change Part D plans
  • drop Part D coverage, which may result in penalties if you have no prescription coverage

General enrollment and Medicare Advantage open enrollment

From January 1 to March 31, you can change or drop Medicare Advantage plans with Part D coverage or join Original Medicare (parts A and B).

Special enrollment period

The dates for this period depend on your specific plan. It’s reserved for special situations, such as moving to a new address or experiencing a change in coverage.

In most cases, you can join a Medicare Advantage plan with or without drug coverage, enroll in a stand-alone Medicare Part D drug plan, or switch to a different plan altogether.

If you have questions about your Medicare Part D coverage or enrollment periods, you can contact the insurance company that you purchased your coverage from, contact the State Health Insurance Assistance Programs National Network, or call 800-MEDICARE (800-633-4227; TTY: 877-486-2048).

It’s a good idea to sign up for a Part D plan when you become eligible, even if you’re not taking any prescription medications.

This is because Medicare adds a permanent 1% late enrollment penalty to your premium if you don’t enroll within 63 days of your initial eligibility period.

The penalty rate is calculated based on the national premium rate for the current year, multiplied by the number of months you did not enroll when you were eligible. So, if you wait to enroll, your extra penalty payment will be based on how long you went without Part D coverage, and this can add up.

The base premium changes year to year. If the premium goes up or down, your penalty changes, too.

If you have a Medicare Advantage plan, when you turn 65 years old, you still need to have Part D coverage.

You can avoid the penalty if you have Medicare creditable coverage from another plan. This means you have drug coverage that’s at least equal to the basic Medicare Part D coverage from another source, like an employer.

Since the penalty can add to your premium cost, it makes sense to buy a Part D plan at low cost when you become eligible. You can change plans during each open enrollment time if you need different coverage.

All Part D and prescription drug plans are offered through private insurance. Availability varies by state.

You can choose between:

  • a standard Part D plan
  • a Medicare Advantage (Part C) plan that includes coverage for all your medical needs (parts A, B, and D)
  • a Medigap plan to help pay for some or all out-of-pocket costs like deductibles and copays that Original Medicare doesn’t cover

Note that new Medigap plans do not cover prescription drug copays or deductibles. And you can’t buy Medigap insurance if you have a Medicare Advantage plan.

The right plan for you depends on your budget, medication costs, and what you want to pay for premiums and deductibles. Medicare has an online tool to help you compare plans in your area for 2024.

If you take specialty or expensive medications or have a chronic condition that requires medications, choose the plan based on what’s covered to give you the most benefit.

Remember, the plan you choose isn’t set in stone. If your needs change year to year, you can switch to another plan during the next open enrollment period. However, you’ll have to stay in the plan for an entire year, so it’s important to choose carefully.

When using the Medicare plan finder tool to choose a Part D plan, you can enter your medications and doses, then select your pharmacy options. Of the available drug plans, you’ll see the lowest monthly premium plan displayed first. Keep in mind that the lowest premium plan may not necessarily fit your needs.

A drop-down selection to the right of the screen lists three options: lowest monthly premium, lowest yearly drug deductible, and lowest drug plus premium cost. Click through all the options and look at your choices before making a final decision.

Here are some tips to keep in mind:

  • Choose a plan based on your overall health and medication needs.
  • Where you live — such as in multiple states during the year or in a rural location — might affect available plans. You can contact Medicare for help with choosing an option that might work for you.
  • Your out-of-pocket costs for premiums, deductibles, and copays can vary with plans. Review what plans do not cover. Add the costs of non-covered items and then compare that to lower premiums to see which option is better.
  • Medicare rates plans from 1 to 5, based on member surveys and certain criteria. Check the plan rating before making your decision. You can switch one time into a 5-star plan from a lower-rated plan between December 8 and November 3.
  • You can add Medigap coverage for out-of-pocket costs if you have Original Medicare with Part D coverage.
  • If you have doctors and pharmacies you like, make sure they’re listed in the network of your plan.

Medicare Part D is an important benefit that helps pay for prescription drugs, which are not covered by Original Medicare (parts A and B).

You can add a medication plan to your Original Medicare coverage with Part D, or you can choose a Medicare Advantage (Part C) plan with drug coverage.

Part C plans may also provide dental and vision benefits. Keep in mind that premiums may be higher, and you might have to go with in-network doctors and pharmacies.

If you have prescription drug coverage through your employer or union that’s at least as good as basic Medicare coverage, you can keep that plan. Go with what gives you the best coverage at the best rate.

Remember, a permanent penalty will be added to your premium if you don’t choose a drug plan or have drug coverage when you’re eligible.