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Who qualifies for Medicare Part D?

General Eligibility

Part D enrollment is open to anyone with Medicare coverage, even those who only have Medicare Part A or Part B. Medicare eligibility typically begins at age 65, provided you or your spouse have worked long enough to be eligible for Social Security or similar benefits or have worked for the government and paid Medicare taxes. Medicare coverage is also available to the permanently disabled who have received disability benefits for upwards of two years and those with specific illnesses. If you would like a Medicare Advantage Plan with prescription drug coverage (commonly referred to as an MA-PD), you will need to have coverage through both Medicare Part A and Medicare Part B before you can enroll. Please also note that if you are already on an MA-PD plan and then apply for coverage through a standalone Part D plan, you will be unenrolled from the Medicare Advantage Plan and switched back to Original Medicare plus the Part D plan you enrolled in. Those with End-Stage Renal Disease, also known as permanent kidney failure or ESRD, will typically not be able to purchase MA-PD plans, though they can still receive coverage through a normal Part D plan.

Service Areas and Residency Requirements

As with many other privately-offered Medicare plans, you will need to live within the service area of any prescription drug plan you choose to enroll in. Most standalone Medicare Part D plans offer coverage nationwide, but Medicare Advantage Plans with prescription drug coverage will often only cover specific regions, such as a state or even select counties within a state. This is of particular concern to those who travel frequently or live in different areas throughout the year, though some MA-PD plans may allow you to take your coverage on the go. You may not enroll in Medicare Part D if you live outside of the United States. Here, the “United States” is defined as all 50 states plus Washington D.C., American Samoa, Guam, the Northern Mariana Islands, and Puerto Rico. If you live outside the US for a time and then return, you can become eligible for Part D when you come back. Those who are currently incarcerated are also ineligible for Part D coverage, but may regain eligibility when released.

There are no other restrictions on eligibility for Medicare Part D.

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