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

With Medicare and Medicaid together, Part D pays for your drugs, you get Extra Help without applying, and you can change drug plans more often than once a year.

Updated September 3, 2026 · 3 min read · by Gerino Alejos

If you have both Medicare and Medicaid, Medicare Part D pays for your prescriptions, not Medicaid. You get Extra Help, the program that lowers drug costs, without applying, and you can change drug plans more often than most people.

Medicare pays for your drugs, not Medicaid

Once you are on Medicare, your prescriptions come through Part D instead of Texas Medicaid.

Medicaid may still cover a small number of items that Part D leaves out by law. Ask about your specific medications instead of assuming.

You get Extra Help automatically

Full dual eligibles, people who have full Medicaid along with Medicare, qualify for Extra Help without applying. Extra Help brings five things.

• No plan premium, the monthly bill for the plan, or a very low one
• No deductible, the amount you pay before the plan pays, or a very low one
• Low fixed copays, the set amount you pay per prescription
• The late enrollment penalty waived entirely
• More chances to change plans during the year

Partial dual eligibles also qualify automatically. That means people on a Medicare Savings Program, such as QMB, SLMB or QI, the state programs that help pay Medicare costs. See how Extra Help works.

You may be auto enrolled in a plan

If you do not choose a Part D plan, Medicare assigns you one so you are not left without coverage.

An auto assigned plan is chosen to be low cost, not to fit your medications. If you take anything specific, check whether the assigned plan covers it well.

You can change plans more often

Most people can only change plans from October through December. Dual eligibles and people with Extra Help generally get extra chances to change plans during the year. How often 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.

Look at a dual eligible plan

There is a kind of Medicare Advantage plan built for people with both programs, called a Dual Eligible Special Needs Plan (D-SNP). Its benefits are coordinated between the two programs, and your share of the cost is very low. These plans are widely available in Hidalgo County.

See how dual eligible special needs plans work.

If your Medicaid status changes

Losing Medicaid or a Medicare Savings Program changes your Extra Help status, and it opens a special enrollment period, an extra window to change plans. There is usually a grace period before your help ends.

Act during that window, not after it. If you lost Medicaid because your income changed, apply again, since the limits change every year.

If you are not on Medicaid but your income is limited

Apply anyway. Medicare Savings Program limits are higher than most people expect. Qualifying brings Extra Help with it, and the program pays your Part B premium, the monthly bill for the part of Medicare that covers doctor visits.

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

Start by checking whether your current drug plan covers everything you take. If it does not, or you are not sure what you have, call our McAllen office or send us your ZIP code through the form on this page.

Gerino Alejos

Licensed insurance agent · License 3128710 · NPN 18243381

Owner of McAllen Insurance Group, an independent agency on North 10th Street in McAllen. Works with clients across Hidalgo, Cameron and Starr counties on Medicare, Marketplace health, life and auto coverage. Se habla español.