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May 27, 2013

Eligibility Requirements for Texas Medicare Part D


Texas Medicare Part D Eligibility

Medicare covers over 40 million people in the U.S. and is the primary insurance provider for most of the population over the age of 65. Understanding eligibility for Medicare drug coverage is essential for all Medicare beneficiaries.

For U.S. citizens and permanent legal residents for five continuous years or more, Medicare Part A eligibility and Medicare Part B eligibility begins at age 65 for anyone receiving Social Security or Railroad benefits. If you (or a spouse) have not worked at least ten years in a Medicare-covered employment, you may still meet eligibility requirements, but pay a higher monthly premium. Anyone under the age of 65 could get Part A eligibility and Part B eligibility if you have received disability benefits for more than two years or have certain chronic conditions.

Although Part A eligibility and Part B eligibility occurs automatically, Texas Medicare Part D eligibility is not automatic. There are two general components of Part D eligibility. First, you must have eligibility and enrollment in Part A or Part B to receive Medicare Part D eligibility. Secondly, in order to get Medicare Part D eligibility for specific plans, you must live in the service area for the Part D plan in which you want to enroll. If you live abroad, you cannot get Part D eligibility as you do not meet the eligibility requirement of permanently living in a Part D plan's service area. In addition, providers cannot impose additional eligibility requirements for enrollment other than those permitted by CMS.

To determine what plans are available in your area for your Part D eligibility, visit PlanPrescriber's Medicare Part D plan comparison tool.

Texas Medicare Part D Eligibility and Penalties

Medicare requires all beneficiaries who have Part D eligibility to have creditable Part D prescription drug coverage that covers as much as Medicare Part D. You must get this coverage within the initial Part D enrollment period of your Part D eligibility if you do not have creditable drug coverage. Failure to join Part D or a Medicare Advantage plan with drug coverage during your initial Part D eligibility may result in penalties and a delay in Part D coverage.

The penalties for failure to sign up during initial Part A eligibility, Part B eligibility, and Part D/Advantage eligibility are listed below.

  • Part A Eligibility - 10% of the premium for twice the number of years you failed to join after the initial Part A eligibility period.

  • Part B Eligibility - 10% of the premium for each year the individual failed to join after the initial Part B eligibility period on all future premiums.

  • Part D/Advantage Eligibility - 1% of the current national base premium times the number of months without creditable Part D coverage on all future premiums.

Texas Medicare Part D Eligibility and Exemptions

There are situations that exempt certain people from paying penalties for not enrolling in Part A and B or Medicare Part D during initial eligibility.

  • Part A and B Eligibility - Already have insurance through employer or union group health plan. If you were younger than 65, on Medicare due to a disability or chronic condition, and charged a penalty, it will be waived once you turn 65 and qualify for Medicare based on age.

  • Part D Eligibility - Already have a private prescription drug plan that qualifies as creditable Part D coverage. Penalty is also waived if you have eligibility for the Part D Low-Income Subsidy program.

Medicare has neither approved nor endorsed this information.