Comparing Part D Prescription Drug Plans

• by Christian Worstell
• July 6, 2021

Medicaid works with Medicare in several ways, and Medicaid works particularly close with Medicare Part D. 

Medicare Part D is sold by private insurance companies and provides coverage for prescription drugs. Medicaid is a publicly-funded program that provides health insurance benefits for low-income adults and children. 

Let’s examine the relationship between Medicaid and Medicare Part D. 

Can I get Medicaid prescription drug coverage?

While prescription drug coverage is an optional Medicaid benefit (which means individual state Medicaid programs decide how drugs are covered in that state), all states in America provide Medicaid drug coverage to eligible beneficiaries.

Beneficiaries who are eligible for both Medicaid and Medicare can get Part D prescription drug coverage through the Medicare Extra Help program or a Medicare Special Needs Plan. We explain more about each of those programs below.

There are certain types of prescription drugs that are typically not covered by Part D plans but may be covered by Medicaid.

These include drugs for:

• Weight loss or weight gain
• Fertility
• Hair growth and other cosmetic purposes
• Cold symptoms
• Vitamins and minerals
• Over-the-counter drugs

Contact your state Medicaid program for information about Medicaid eligibility and enrollment. 

What is Medicare Extra Help?

Medicare Extra Help is a program that helps people with limited income and financial resources pay for Medicare Part D costs such as premiums, deductibles and copayments. If you qualify for both Medicaid and Medicare, you automatically qualify for Extra Help. Extra Help is also referred to as the Part D Low-Income Subsidy (LIS). 

Extra Help supports Medicaid beneficiaries in three key ways:

1. Lower Part D premiums
   You will pay a reduced premium for your Part D plan when enrolled in Extra Help.
   
   
2. No deductible
   Part D plans may include a deductible of up to $445 in 2021, but Extra Help eliminates any deductibles.
   
   
3. No coverage gap
   Although the Part D coverage gap (or “donut hole”) was recently closed, some beneficiaries may still see increased costs for drugs after going over a certain limit. But Extra Help members have no coverage gaps to deal with. 

To qualify for Extra Help in 2021, you must earn no more than $26,100 for a married couple or $19,380 if not married. In addition, your financial resources must be worth less than $29.520 for married couples or $14,790 if not married. If your income or financial resources are close to these limits, or if you’re unsure about your eligibility, you can still reach out to Medicare to learn more about whether you can apply for Extra Help.

Again, if you qualify for Medicaid you will be automatically eligible for Extra Help.    

What are Medicare Special Needs Plans (SNPs)?

If you are eligible for both Medicare and Medicaid, you may also be eligible to join a Dual-eligible Special Needs Plan (D-SNP). This is a certain type of Medicare Advantage plan that offers all of the same coverage as Medicare Part A and Part B along with additional benefits that are tailored to the needs of someone with limited income and resources.

All Medicare Advantage Special Needs Plans must include coverage for prescription drugs. 

Learn more about Medicare Special Needs Plans and D-SNPs, and find out if there are any plans available where you live. You can compare Medicare plans online, including what drugs they cover and what pharmacies are part of the plan network. You can also call to speak with a licensed insurance agent to learn more.

About the author

Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.

His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.

Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.

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