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Medicare Part D Eligibility

Eligibility for Medicare Part D is also for those who do not already have “creditable” prescription drug coverage. Creditable prescription drug coverage (for example, from an employer or union) is coverage that is expected to pay at least as much as Medicare’s standard prescription drug coverage.

People who have this kind of “creditable” coverage when they become eligible for Medicare can generally keep that coverage without paying a penalty, if they decide to enroll in Medicare prescription drug coverage later.

However, if you do not have “creditable” prescription drug coverage and you do not enroll in a Part D plan or a Medicare Advantage plan with prescription drug coverage when you are first eligible, you may be required to pay a “late enrollment” penalty if you later enroll in a Part D plan.

Here are a few examples of creditable coverage:

  • Covered by pension program. Some seniors receive prescription drug coverage as part of their pension package. They would normally not be eligible for Medicare Part D.
  • Covered by employer. If a Medicare enrollee is currently employed and his or her employer provides prescription drug coverage, they would normally not be eligible for Medicare Part D.
  • Covered by union. Many unions offer prescription drug coverage for their retired members. They would normally not be eligible for Medicare Part D.
  • Covered by a Medicare Advantage Plan. Many Medicare Part C (Medicare Advantage) programs already include prescription drug benefits. They would normally not be eligible for Medicare Part D.

Calling the numbers above will direct you to a licensed insurance agent/broker Monday – Friday: 8am – 5pm. For more information, call toll free 1-877-651-7526 TTY 711 (national relay). HRBC Insurance represents various Medicare Advantage (MA) and Prescription Drug Plans (PDPs) as well as other types of health plans. Each of these Medicare Advantage plans has a separate contract with Medicare to offer Medicare Advantage plans. Enrollment in one of these Medicare Advantage plans depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, premium and/or co-payments/ co-insurance may change on January 1 of each year. Limitations, copayments, and restrictions may apply. This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance and deductibles may vary based on your Medicaid eligibility category and/or the level of “Extra Help” you receive. Please contact the plan for further details.

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1) Information related to plans and products indicated above.

2) Scheduling an in-home visit to discuss these plans or products indicated above.