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Are there any Medicare Part D prescription drug plans that are free for Medicare beneficiaries who receive Medicaid or Extra Help?

Category: Extra Help - LIS - Medicaid
Updated: Apr, 09 2023


No.  There are no Medicare Part D plans that are totally "free" to low-income Medicare beneficiaries, but there are plans with a $0 (or low) monthly premium, no deductible, no coverage gap, and very low drug costs.

If a Medicare beneficiary is dual eligible for both Medicare and Medicaid or receives "full" Medicare Part D Extra-Help (or the Low-Income Subsidy (LIS)), then they will find that their state has several Medicare Part D plans that qualify for the $0 monthly premium.

If you wish to see the Medicare Part D plans in your home state that qualify for the $0 monthly premiums, you can use our PDP-Finder (here is an example for South Carolina): PDP-Finder.com/SC/LIS

Also, people who qualify for the full Low-Income Subsidy will have their formulary medications covered by their Medicare Part D plan at a very low price.  For example, the copayment is $1.45 for generic medications and for brand-name medications $4.30 in 2023 for people at or below 100% FPL. Beneficiaries at or below 135% FPL pay $4.15 in 2023 for generics and $10.35 for brand-name medication.

If someone is over the "full" Extra-Help limits, they may still take advantage of lowered monthly premiums (although not $0) and also reduced prescription drug copayments - depending on their financial resources.

Here is link to the 2023 Medicare Part D plan parameters and Extra Help limits (at the bottom of the table): Q1Medicare.com/2023#chart.



In 2024, the copayment is $1.55 for generic medications and for brand-name medications $4.60 for people at or below 100% FPL. Beneficiaries at or below 150% FPL pay $4.50 in 2024 for generics and $12.20 for brand-name medication.  See Q1Medicare.com/2024#chart.

Keep in mind that 2023 is the last year for partial Extra Help.  For plan year 2024, the Inflation Reduction Act (IRA) of 2022 increases full Extra Help benefits to people at 150% of FPL and consequently, the current partial Extra Help (135% to 150% of FPL) designation will be eliminated.

Please note that the financial limits that define the different levels of the Extra-Help program will change every year.

To apply for the Extra-Help program, contact your local Medicaid office or the Social Security Administration at: 1-800-772-1213.





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