Part D for dual-eligible beneficiaries
If you have both Medicare and Medicaid, your prescription drug coverage works differently — and costs much less.
The key thing to know
Even though you have Medicaid, Medicare Part D — not Medicaid — covers your prescription drugs. But because you're dual eligible, you automatically get Extra Help (the low-income subsidy), which covers most or all of your Part D costs.
What Extra Help covers for dual eligibles in 2026
As a dual-eligible beneficiary, you qualify for the full Extra Help benefit:
- $0 monthly premium — your Part D premium is fully covered
- $0 deductible — you skip the annual deductible entirely
- Low copays — no more than $12.65 per brand-name drug and $5.10 per generic drug
- Even lower copays with QMB — if you're in the QMB program, copays max out at $4.90 per drug
- $0 after the cap — once your spending reaches $2,100, you pay nothing for the rest of the year
- No late enrollment penalty — gaps in coverage don't result in a permanent penalty
Automatic enrollment
If you have full Medicaid benefits, CMS will automatically enroll you in a Part D plan and the Extra Help program. You'll receive a letter confirming your enrollment and your plan assignment.
Important: the plan CMS assigns you may not be the best one for your medications. You have the right to switch to a different plan — and as a dual-eligible beneficiary, you can change plans once per month, not just during open enrollment.
Can you switch Part D plans?
Yes — and more easily than most people. As a dual-eligible beneficiary, you have a Special Enrollment Period every month. This means you can:
- Switch to a Part D plan that better covers your specific medications
- Move to a plan with a pharmacy closer to you
- Switch between a standalone Part D plan and a D-SNP (which includes drug coverage)
A Local Medicare Agent or your state SHIP counselor can help you compare plans and find one that covers all your drugs at the lowest cost.
What if Medicaid covered a drug that Part D doesn't?
It's possible for a drug to be covered by Medicaid but not by your Part D plan's formulary. In these cases:
- Check if another Part D plan covers the drug (you can switch monthly)
- Ask your doctor to request a formulary exception from your plan
- In some cases, Medicaid may still cover certain drugs that Part D explicitly excludes
LINET: temporary coverage while you get enrolled
If you qualify for Extra Help but aren't enrolled in a Part D plan yet, the Limited Income Newly Eligible Transition (LINET) program provides temporary drug coverage. LINET ensures you can fill prescriptions while your Part D enrollment is processed. Call 1-800-783-1307 for LINET information.
Ready to take the next step?
There are several free ways to get help with your Medicare and Medicaid coverage:
You can also visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227)