This post explains how Medicare and Medicaid work together, and also describes Medicare’s Extra Help program for prescriptions.


Medicare has some great programs that they run in conjunction with Medicaid. Medicaid qualifications vary from state to state, so if you are not on Medicaid, you should apply with your state to see if you can qualify. States have different ways of evaluating your income and resources, so be sure to apply if you consider yourself low income. If you can’t find your state Medicaid office phone number online, then you can call 800-Medicare and they will tell you the phone number.

There are seven different levels of Medicaid help and most of them will pay either some or all of your Part B premium—that $170.10 that you may be worried about. Here is a chart for those levels of benefit. The seven different levels are across the top. And down the left side are the various benefits that you can get with that level of Medicaid help.

Three of these levels provide super generous benefits with Medicare Advantage plans, where you not only get the Part B premium paid, but you also can get your Medicare Advantage premium paid plus any copays, deductibles, coinsurance, and very generous extra benefits for dental, vision, hearing, transportation, over the counter benefits, and more sometimes.

When you receive your letter of acceptance from Medicaid, it should tell you which level of Medicaid you qualified for. If you don’t have the letter, reach out to me. I can look it up and tell you whether you qualify for the special programs. We call those “dual eligible” programs because you’re eligible for both Medicare and Medicaid.

These dual eligible programs are a great deal financially, but they also offer much more lenient guidelines with respect to dates for you to sign up. Instead of only being able to change your plan once per year, if you are dual eligible, you can change it once per quarter during the first nine months of the year, if you need to.

Caution: If you lose your Medicaid status, or it drops down to a lower level of help, you will no longer qualify for the dual eligible Medicare Advantage plan, so we will need to switch you to another plan that is not as generous.

Most of the time when this happens it’s because somebody didn’t keep up with the paperwork. They didn’t receive their form in the mail or the form came but they didn’t understand it was important. I encourage you to be really on top of the paperwork, know which month it is that you have to refile that paperwork and not lose the Medicaid coverage. It’s a big headache if that happens, not to mention expensive for you if you need medical care.

Extra Help with Prescriptions

In addition to the Medicaid program, there’s another program that Medicare runs called “Extra Help.” Extra Help subsidizes your prescription costs and will also waive a Part D late enrollment penalty if you have one.

Some people who do not qualify for Medicaid will qualify for Extra Help. They will evaluate both income and resources (assets) to determine whether you qualify.

If you already have Medicaid or are receiving an SSI check, you will automatically be enrolled in Extra Help.

Apply for Extra Help

Help is free!

I’m Laraine Sookhoo and I’m passionate about helping you understand your Medicare options so you can get the most out of your Medicare benefits. My help is free, so book an appointment to get started!

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