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Medicare Part D Enrollee Characteristics

Medicare is a health insurance program administered by the federal government's Centers for Medicare and Medicaid Services, with the Social Security Administration determining eligibility and processing payments. Medicare comes in four parts: A, B, C and D. Medicare Part D offers prescription drug coverage and is offered through private companies. To enroll in Part D, you must first meet certain requirements.

  1. Eligible for Medicare

    • You must be eligible for Medicare in order to enroll in Part D, and this requires meeting certain conditions. Most people who are eligible for Medicare are 65 or older. However, people of any age who have certain disabilities, or who have end-stage renal disease (permanent kidney failure needing a kidney transplant or regular dialysis) may also be eligible to enroll in Medicare Part A and/or B.

    Enrolled in Part A

    • You must enroll in Medicare Part A or Part B in order to enroll in Medicare Part D. If you are still waiting to participate in either, you will not be able to join Part D. Some companies will allow you to enroll once you have either Part A or Part B, but Medicare Advantage plans will not let you join unless you have both.

    Need Prescription Drug Coverage

    • Medicare Part D is prescription drug coverage only. You will get other benefits if you enroll in a Medicare Advantage plan, but Part D itself only covers prescriptions. If you do not need this or do not want it, there is no reason to sign up for Part D. Medicare Part D is completely offered through private companies working with Medicare, so the drugs covered by each plan and the costs involved differ. Some companies only add Part D to original Medicare, while others will add it to Medicare medical savings account plans, Medicare cost plans and Medicare private fee-for-service plans.

    Live in the Service Area

    • You must get Medicare Part D from a company that serves your area. You can't go with a company offering lowering premiums in New York if you live in Washington. You can search by zip code, Medicare number and other criteria for a list of companies that offer Part D and Medigap policies on the Medicare.Gov website.

    Able to Pay the Costs

    • Unlike Medicare A (and sometimes B), Medicare Part D is not free, whether it is included in your Medicare Advantage plan or as an addition in itself. You will have to pay monthly premiums, so everyone who wants to use Part D has to be able to regularly meet the financial challenge. How much you have to pay depends on the company you get it from, whether or not it is part of Medicare Advantage and where you live. Part D plans may also come with deductibles--the amount you pay for your medicine before the plan starts paying the costs. Other plans may also require that you make co-payments, a set amount, or co-insurance, a percentage of the cost.

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