---
kind: "section"
citation: "42 C.F.R. § 423.30"
title: "42"
number: "423.30"
heading: "Eligibility and enrollment."
url: "https://uscodex.org/cfr/42/423.30"
---

# §423.30. Eligibility and enrollment.

- (a) **General rule.**
  - (1) **An individual is eligible for Part D if he or she does all of the following—**
    - (i) 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)](/cfr/42/407.1.md?p=a-6)) of this subchapter.
    - (ii) Lives in the service area of a Part D plan, as defined under [§ 423.4](/cfr/42/423.4.md).
    - (iii) Is a United States citizen or is lawfully present in the United States as determined in [8 CFR 1.3](/cfr/8/1.3.md).
  - (2) Except as provided in paragraphs [(b)](#b), [(c)](#c), and [(d)](#d) of this section, an individual is eligible to enroll in a PDP if:
    - (i) The individual is eligible for Part D in accordance with [paragraph (a)(1)](#a-1) of this section;
    - (ii) The individual resides in the PDP's service area; and
    - (iii) **The individual is not enrolled in another Part D plan.**
  - (3) **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.
- (b) **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:
  - (1) 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
  - (2) 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).
- (c) **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.
- (d) **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](/cfr/42/part417.md) 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)](#a-2) of this section.

## Notes

### 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]