How to Prove You Have Medicare Part D Coverage

By Patricia Barry

Copyright © 2015 AARP. All rights reserved.

When a Medicare Part D plan accepts your enrollment, your name and information is uploaded into the pharmacy computer system. So normally, you don’t have to prove anything: Just go to the pharmacy with your prescription (or have your doctor call it in), show your plan membership card, and pay whatever’s due.

But when you head to the pharmacy for the first time under a new Part D plan, the pharmacist needs to verify your coverage. That’s likely to be a straightforward process, too. But what if you haven’t yet received your card or your enrollment information isn’t yet in the computer system? The following tips help avoid or minimize delays:

  • Pick the right pharmacy. Make sure that the pharmacy you go to is in your plan’s network. You can find out which local pharmacies are in-network and which, if any, are preferred pharmacies by using the plan finder program on Medicare’s website, looking at your plan’s information packet (if you’ve received it), or calling the plan. Or you can call ahead to a pharmacy to make sure it’s in your plan’s network.

  • Have the pharmacist call the plan to confirm that you’re enrolled if you haven’t gotten your membership card. You can help by providing the pharmacist with as many of the following as possible:

    • The plan’s name

    • A letter from the plan confirming your enrollment

    • A letter from the plan acknowledging your enrollment request (or a copy of your enrollment request if the plan hasn’t sent acknowledgment or confirmation)

    • A photo ID

  • Bring your Extra Help documentation if you qualify because of limited income. Your plan’s membership card should be enough to confirm your eligibility for low-cost Part D drug coverage under the Extra Help program. But if you haven’t yet received the card, bring one of these items with you:

    • Your Extra Help confirmation letter from Social Security or Medicare, or any recent letter you’ve had from either agency

    • A copy of your Extra Help application if you filled one out

    • Your Medicaid card if you’re receiving benefits from your state medical assistance program

    • Any documents or recent letters confirming that you receive Supplementary Security Income (SSI) or have your Medicare premiums paid by your state