If you have Medicare Medicare is the federal government health insurance program that provides health care coverage if you are 65 or older, are under 65 and receive Social Security Disability Insurance (SSDI) for 24 months, begin receiving SSDI due to ALS/Lou Gehrig’s Disease, or have End-Stage Renal Disease (ESRD) no matter your age. You can receive health coverage directly through the federal government (see Original Medicare) or through a private company (see Medicare Advantage). and Medicaid Medicaid is a federal and state program that provides health coverage for certain people with limited income and assets. (dually eligible), your drugs are usually covered by Part D and Extra Help. 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 A prescription is an order for a health care service or drug written by a qualified health care professional. 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 A copayment, also known as a copay, is a set amount you are required to pay for each medical service you receive (like $35 for a doctor’s visit). for prescriptions that are covered by Medicaid in your state. Keep in mind that all states have a Medicaid formulary The formulary is the list of prescription drugs covered by a Part D plan or Medicare Advantage Plan. If your drug is not on the formulary, you may have to request an exception, file an appeal, or pay out of pocket. . 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 you. For more information understanding how Medicaid may help pay for medications, call your State Health Insurance Assistance Program (SHIP).