Medicaid & Medicare Part D

Medicaid and Medicare are both government health insurance programs. Medicare covers retired people, while Medicaid covers the poor. Medicare also has a drug benefit, called Part D. In some cases, people will qualify for both sets of coverage. Those with Medicare Part D and Medicaid may avoid service denials by understanding how their coverage works.

Medicaid Drug Coverage

When a beneficiary is eligible for both Medicare and Medicaid, Medicare Part D typically becomes the default prescription drug coverage. Medicare will begin paying for all prescription drugs instead of Medicaid.

Extra Help

Those with Medicaid are automatically enrolled into a Medicare assistance program called Extra Help. Extra Help is administered by Social Security and helps Medicaid beneficiaries pay for drug co-payments and their Part D premium. Most Medicaid beneficiaries who have Extra Help pay next to nothing for their prescription drugs.

Excluded Drugs

Medicaid offers drug coverage in limited circumstances. In some states, Medicaid covers drugs if they are considered excluded by Medicare. These are any drugs that fall in the classes of benzodiazepine, barbiturate, vitamins, over-the-counter drugs, drugs for weight gain and weight loss and more.

Non-Formulary Drugs

Medicaid sometimes provides coverage (called a Medicaid wrap) for drugs that are not on the Part D plan’s formulary or, in other words, are not covered by the Part D plan, even if the drug is not excluded by law.