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Will Medicaid pay for prescriptions if I have Medicare?

Published in Dual Eligibility Benefits 2 mins read

If you have both Medicare and Medicaid, a status known as being "dually eligible," Medicare is the primary payer for your prescription drugs. Medicaid's role is typically secondary, covering costs after Medicare has paid its share.

Understanding Prescription Drug Coverage for Dual Eligibles

Individuals who qualify for both Medicare and Medicaid benefits receive comprehensive health care coverage. This dual eligibility helps ensure that your medical and prescription drug costs are well-managed.

Medicare's Primary Role in Prescription Coverage

For dually eligible individuals, Medicare, specifically through a Medicare prescription drug plan (Part D), is responsible for covering most of your prescription medications.

  • Medicare pays first for Medicare-covered services, which include your prescription drugs. This means your Part D plan will process and pay for your prescriptions initially.

Medicaid's Secondary Role

Medicaid serves as the "payer of last resort" for dual eligibles. This means it steps in to cover costs only after Medicare and any other health insurance you may have have paid their share.

  • Medicaid pays last, providing crucial assistance by helping to cover the out-of-pocket costs associated with your Medicare Part D plan.
  • This can include assistance with monthly Part D premiums, deductibles, copayments, and coinsurance, significantly reducing or even eliminating your out-of-pocket expenses for covered prescriptions.

How Benefits Coordinate for Prescriptions

The coordination between Medicare and Medicaid ensures that your prescription drug needs are met efficiently, minimizing your financial burden.

Here's a simplified view of how prescription costs are typically managed:

Payer Role for Prescription Drugs (Dual Eligibles)
Medicare Provides primary coverage for prescription drugs
Medicaid Helps with remaining out-of-pocket costs

This coordination means that while Medicare covers the core cost of your prescription drugs, Medicaid provides a safety net, making your medications much more affordable.

What This Means for You

Being dually eligible offers substantial financial protection and access to necessary medications. It provides peace of mind knowing that your prescription drug costs are largely covered.

  • Reduced Out-of-Pocket Costs: You will likely pay very little, if anything, for your Medicare-covered prescription drugs.
  • Streamlined Access: The coordinated benefits help you get the medications you need without significant financial barriers.

For more detailed information on how Medicare and Medicaid work together, you can visit the official Medicare website: Medicaid - Medicare.gov.