Medicaid Coordination with Part D (By State)

People who have both Medicaid and Medicare must get their prescription drugs through a Medicare Part D prescription drug plan.* The chart below shows which drugs Medicaid covers for people with Part D in different states and how much these prescriptions cost. Use the chart's scroll bar to find your state and see the rules in your area.

*Note: If you will lose your retiree or union coverage by enrolling in a Medicare private drug plan, you may not have to take Medicare drug coverage. Call your local Medicaid office to find out what to do if you may lose your retiree/union coverage.

In most states, Medicaid wraps around Medicare Part D to cover some drugs that are excluded from Medicare coverage by law. Drugs that may be covered by Medicaid that are excluded from Medicare coverage by law include

• certain anti-anxiety drugs (barbiturates and benzodiazepines);
• anorexia, weight loss or weight gain drugs;
• fertility drugs;
• drugs for cosmetic purposes or hair growth;
• drugs for relief of the symptoms of colds, like a cough and stuffy nose;
• prescription vitamins and minerals (except prenatal vitamins and fluoride preparations); and
• non-prescription drugs (over-the-counter drugs).

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

You will only pay a small copayment for prescriptions that are covered by Medicaid in your state. If you are in a Medicaid private health plan, your copayments and prescription drug benefits may be different. Check with your plan for more specific information.

Keep in mind that all states have a Medicaid formulary, or list of covered drugs. Even if your medication is in a category of drugs that is covered through Medicaid wrap in your state, it must usually be on Medicaid’s formulary in order for it to be covered for you. If you need a prescription that is not on the Medicaid formulary, there should still be a way to have Medicaid cover the prescription.

To find out more specific coverage rules, contact your state Medicaid office. The chart below includes links to state Medicaid offices.

CHART: Medicaid Coordination with Part D (By State)

(Scroll down on the right side of the chart to see how Medicaid works with Medicare in your state.)