Blog / Part D

What happens to my Part D if I have Medicaid too?

Dual eligibles get automatic Extra Help, automatic plan enrollment, and more chances to switch. Here is what to know so the automatic part works for you.

Updated August 17, 2026 · 2 min read

If you have both Medicare and Medicaid, your drug coverage works differently and considerably better. This affects a lot of people in this county.

Medicare pays for your drugs, not Medicaid

Once you are on Medicare, your prescriptions come through Part D rather than Texas Medicaid. That transition catches people who had Medicaid drug coverage first.

Medicaid may still cover a small number of items Part D excludes by law. Ask about specific medications rather than assuming.

You get Extra Help automatically

Full dual eligibles qualify for Extra Help without applying. That means:

• No or very low plan premium
• No or very low deductible
• Low fixed copays per prescription
• The late enrollment penalty waived entirely
• More opportunities to change plans during the year

Partial dual eligibles, meaning people on a Medicare Savings Program such as QMB, SLMB or QI, also qualify automatically. See Extra Help.

You may be auto enrolled in a plan

If you do not choose a Part D plan, Medicare will assign you one so you are not left without coverage. That is helpful and it is also somewhat arbitrary.

You can change plans more often

Rather than being locked to October through December, dual eligibles and Extra Help recipients generally get additional opportunities to change plans during the year. The exact frequency depends on your level of eligibility.

So if your assigned plan is a poor fit, you usually do not have to live with it until January. Ask rather than assuming you are stuck.

Look at a dual eligible plan

There is a category of Medicare Advantage plan built specifically for people with both programs, with coordinated benefits and very low cost sharing. These are widely available in Hidalgo County.

See dual eligible special needs plans.

If your Medicaid status changes

Losing Medicaid or a savings program changes your Extra Help status, and it opens a special enrollment window. There is usually a grace period before your subsidy ends.

Act during that window rather than after it. If your income changed and you lost eligibility, it is also worth re-applying, since limits change annually and eligibility rules are not always what people assume.

If you are not on Medicaid but your income is limited

Apply anyway. Medicare Savings Program limits are higher than most people expect, they count fewer resources than people assume, and qualifying brings Extra Help with it along with your Part B premium being paid.

In Texas you apply through Health and Human Services at yourtexasbenefits.com, which is a different agency from Social Security. See how the programs work together.