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Does My Elderly Parent Qualify for Medicare Part D?

Senior parent with child

Are you wondering about your senior parent’s eligibility for Medicare or Medicare Advantage? At MedicareInsurance.com, we may be able to help. Just contact us via our online chat feature today or give us a call at (800) 950-0608 to learn more about your parent’s potential eligibility.

Just the Essentials…

  • Medicare is a government-managed health insurance program made up of four separate parts: Part A, Part B, Part C, and Part D.

  • Medicare Part D is designed to give Medicare beneficiaries additional coverage for prescription medications.

  • Individuals aged 65 or older may qualify for Medicare Part D, as may those diagnosed with certain disabilities and those who have received certain social security benefits.

  • Like all parts of Medicare, there are specific restrictions on when one may enroll in Medicare Part D, and there may be penalties associated with violating these regulations.

  • The Extra Help program is an additional federal program designed to assist certain groups of seniors in paying for their medication.

Understanding Medicare and prescription drug coverage.

Coverage for prescription drugs is an important component of any insurance plan. This is especially true for seniors who need medications but aren’t always able to afford the cost due to a fixed income. That’s where Medicare Part D comes in. 

Learn more about what Medicare Part D is, what it covers, and how your parent may become eligible for it right here at MedicareInsurance.com.

What is Medicare Part D?

Medicare Part D is the prescription drug coverage portion of Medicare. Part D may be able to help your parent pay for their generic and brand-name prescription drugs. These Part D prescription drug plans are offered by private insurance companies that have previously been approved by Medicare. 

Medicare Part D may be available as part of a Medicare Advantage (Medicare Part C) plan, or it may be had as a standalone option. Whatever the case, Medicare Part D coverage can be usually be added to the following health insurance options:

  • Original Medicare
  • Some Medicare Cost Plans
  • Medicare Medical Savings Account (MSA) Plans
  • Some Private-Fee-For Service (PFFS) Plans
  • Some Medicare Advantage Plans
  • Other Medicare Health Plans

Before deciding to enroll in Medicare Part D, your parent should consider all of their prescription drug coverage options before they sign up for a new plan or adding Part D to their existing coverage. 

In some cases, your parent may have drug coverage through another insurance provider or plan. Examples include Medigap, TRICARE, the Department of Veterans Affairs, a union, or an employer. Keep in mind that if your parent decides to add Medicare Part D: Prescription Drug Coverage without first considering the possibility of existing coverage, this coverage may be changed unintentionally.

Who is eligible for Medicare Part D?

One typically becomes eligible for Medicare at the age of 65, or upon the diagnosis of certain diseases and disabilities. If your parent is qualified to receive Social Security Benefits (SSI), Railroad Retirement Board Benefits (RRB), or if they turn 65 while receiving Social Security Disability (SSDI) benefits, they are likely already eligible for Medicare. 

If your parent has a qualifying disability and has received disability benefits from Social Security or the Railroad Retirement Board, they may be able to enroll in Medicare three months before and three months after they receive their 25th benefit payment. Upon turning 65, receiving disability benefits for any length of time means automatic enrollment in Original Medicare Part A and Part B.

When can my parent enroll in Medicare Part D?

Your parent can enroll in any part of Medicare, including Part D, three months before their 65th birthday, the full month of their birthday, and an additional three months after their 65th birthday. This period is known as the Initial Enrollment Period.

There are several times throughout the year when your parent may be able to enroll in or make changes to a drug plan under Medicare Part D. Depending on the type of plan your parent has or is interested in, some of these enrollment periods may not apply to them.

Open Enrollment Period: October 15 to December 7

During the Open Enrollment Period, your parent can switch to a Medicare Advantage plan or switch back to Original Medicare. In addition, they can also sign up for or drop a Medicare Part D: Prescription Drug Coverage plan during this period.

Annual Enrollment Period: January 1 to March 31

During the Annual Enrollment Period, your parent may be able to change or drop Medicare Advantage plans with or without Part D coverage or switch back to Original Medicare if desired. 

Those who already have Original Medicare Parts A and B cannot add standalone Part D coverage during this time.

First Time Part D Enrollment: April 1 to June 30

If your parent is looking to enroll in Medicare Part D for the first time, they may do so during the First Time Medicare Part D Enrollment Period. After this period, your parent may only make changes during the Open Enrollment Period.

What is covered under Medicare Part D?

Medicare Part D is required to cover at least two drugs from each of six classes on the pre-approved Medicare drug list, or formulary. Typically, Medicare Part D is required to cover the following classes of prescription medication:

  • Anti-convulsive treatment for seizures
  • Antidepressants
  • Immunosuppressant medications
  • HIV/AIDS treatments
  • Anticancer drugs (unless covered by Part B)
  • Antipsychotic medications
  • Commercially available vaccines, including the shingles shot
  • Insulin 

Are there any penalties associated with not enrolling in Medicare Part D?

Like other parts of Medicare, your parent may face a penalty if they don’t sign up for Part D when they first become eligible, but decide to do so later. Typically, the late enrollment penalty for Medicare is one percent for each month that one doesn’t enroll. However, there are some exceptions to this rule. 

If your parent already has drug coverage from an employer or through another plan, the Medicare Part D late enrollment penalty does not apply. In addition, if your parent has proof that they received inaccurate information about their current coverage, or if they are eligible to receive prescription drug coverage through the Extra Help program, this penalty may not apply.

What is Extra Help?

Extra Help is a federal program that helps pay for out-of-pocket costs related to Medicare prescription drug coverage. Individuals with a monthly income equal to or less than $2,000, or $3,000 for couples who file taxes jointly, may qualify. Income and assets not accounted for while assessing eligibility may make your parent ineligible if they exceed the income limit.

Those enrolled in Medicaid, Supplemental Security Income (SSI) or a Medicare Savings Program (MSP) will automatically qualify for Extra Help as well.

Finding the best Medicare Part D plan option for your parent can be a challenge Don’t hesitate to call MedicareInsurance.com today at (800) 950-0608 or utilize our live chat feature to speak with a licensed live agent. Our team of experts is happy to help your parent compare healthcare coverage options that best suit their needs.

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