§423.30. Eligibility and enrollment.
42 C.F.R. § 423.30
General rule.
An individual is eligible for Part D if he or she does all of the following—
Is entitled to Medicare benefits under Part A or enrolled in Medicare Part B (but not including an individual enrolled solely for coverage of immunosuppressive drugs under § 407.1(a)(6)) of this subchapter.
Lives in the service area of a Part D plan, as defined under § 423.4.
Is a United States citizen or is lawfully present in the United States as determined in 8 CFR 1.3.
Except as provided in paragraphs (b), (c), and (d) of this section, an individual is eligible to enroll in a PDP if:
The individual is eligible for Part D in accordance with paragraph (a)(1) of this section;
The individual resides in the PDP's service area; and
The individual is not enrolled in another Part D plan.
Retroactive Part A or Part B determinations. Individuals who become entitled to Medicare Part A or enrolled in Medicare Part B for a retroactive effective date are Part D eligible as of the month in which a notice of entitlement Part A or enrollment in Part B is provided.
Coordination with MA plans. A Part D eligible individual enrolled in a MA-PD plan must obtain qualified prescription drug coverage through that plan. MA enrollees are not eligible to enroll in a PDP, except as follows:
A Part D eligible individual is eligible to enroll in a PDP if the individual is enrolled in a MA private fee-for-service plan (as defined in section 1859(b)(2) of the Act) that does not provide qualified prescription drug coverage; and
A Part D eligible individual is eligible to enroll in a PDP if the individual is enrolled in a MSA plan (as defined in section 1859(b)(3) of the Act).
Enrollment in a PACE plan. A Part D eligible individual enrolled in a PACE plan that offers qualified prescription drug coverage under this Part must obtain such coverage through that plan.
Enrollment in a cost-based HMO or CMP. A Part D eligible individual enrolled in a cost-based HMO or CMP (as defined under part 417 of this chapter) that elects to receive qualified prescription drug coverage under such plan is ineligible to enroll in another Part D plan. A Part D eligible individual enrolled in a cost-based HMO or CMP offering qualified prescription drug coverage is eligible to enroll in a PDP if the individual does not elect to receive qualified prescription drug coverage under the cost-based HMO or CMP and otherwise meets the requirements of paragraph (a)(2) of this section.
Notes, amendments, and revision history
Amendments
[70 FR 4525, Jan. 28, 2005, as amended at 80 FR 7962, Feb. 12, 2015; 87 FR 66510, Nov. 3, 2022]
Authority
Authority: 42 U.S.C. 1302, 1306, 1395w-101 through 1395w-152, and 1395hh.
Source
Source: 70 FR 4525, Jan. 28, 2005, unless otherwise noted.
Amendments
[70 FR 4525, Jan. 28, 2005, as amended at 80 FR 7962, Feb. 12, 2015; 87 FR 66510, Nov. 3, 2022]