Medicare Part D Qualifications

Medicare Part D is a government program created under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to help elderly and certain disabled people pay for prescription drugs. Medicare Part D subsidizes the cost of prescription drug coverage. Part D plans are offered by private insurance programs.

Medicare

• You must be eligible for Medicare to enroll in a Part D plan. Medicare eligibility involves being age 65 or older or having a qualifying disability. The Social Security Administration (SSA) determines whether a disability qualifies for Medicare benefits. The disability must prevent gainful employment, and benefits are not awarded solely on the label of the disability except in a few cases. People who have end-stage renal disease or are blind automatically qualify for Medicare benefits.

Time Frame

• Enrollment for Part D plans for the following year begins Nov. 15 in the preceding year. Enrollment lasts until May 15th. Enrollment after this time results in a penalty. This penalty is typically an increase in the cost of the plan.

Plans

• Different Part D plans may have slightly different requirements for enrollment. Many plans are only offered in certain regions. In 2008, the state of Alaska offered the fewest number of Part D plans, 27, while West Virginia and Pennsylvania both offered the most number of plans, 63 each.

Excluded Medications

• Part D plans don't provide coverage for certain types of medications. People who require barbiturates; benzodiazepines; or medications designed specifically for weight loss, fertility, erectile dysfunction, cosmetic purposes, or symptomatic relief of cough and colds will need to pay out-of-pocket or find alternative coverage for these medications. Those who are eligible for both Medicare and Medicaid can use their Medicaid benefits to cover the prescription cost for many of these medications.

Extra Help

• If your income is very low and you qualify for Medicare, Medicare may pay for even more of your prescription drug coverage costs. Medicare may pay co-payments and other expenses that individuals with Part D are typically responsible for. If you want to know whether you qualify for extra help, contact the SSA at [phone].