What is the Eligibility for Medicaid When I Have Medicare Part D?

If you have Medicare and Medicaid (dually eligible), your drugs are usually covered by the Medicare Part D prescription drug benefit and Extra Help (see How Do I Use Extra Help to Eliminate my Part D LEP?). In cases like those described below, Medicaid may cover drugs that Medicare does not.

In many states, Medicaid covers some of the drugs that are excluded from Medicare coverage by law. Drugs excluded from Medicare coverage by law that may be covered by your state’s Medicaid program include

  • Drugs for:
    • Anorexia, weight loss, or weight gain
    • Fertility
    • Cosmetic purposes or hair growth
    • Relief of cold symptoms (like a cough or stuffy nose)
  • Prescription vitamins and minerals (except prenatal vitamins and fluoride preparations)
  • Non-prescription drugs (over-the-counter drugs)

In some states, Medicaid covers additional medications for people with Part D.

You will only pay a small copayment for prescriptions that are covered by Medicaid in your state. Keep in mind that all states have a Medicaid formulary, which is a list of covered drugs. For more information on the Medicaid formulary in your state, ask your pharmacist or contact your local Medicaid office. If you need a prescription that is not on the Medicaid formulary, you may still be able to have it covered.

For more information understanding how Medicaid may help pay for medications, call your State Health Insurance Assistance Program (SHIP) by calling 877-839-2675 or visiting shiptacenter.org.

Read Next: How Does Medicaid Work?
Learn About: Everything You Need to Know About Medicaid and Medicare.
Return to: Medicare Admin

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