Texas Medicare Rx Program
Full Dual Eligible Beneficiary
Your selection tells us Medicare or Medicaid sometimes pays for your medical services or those of the person for whom you are caring.
The information presented in this section of the Web site addresses your specific situation as it relates to the Medicare Part D prescription drug program. More detailed information is available at the website for the Texas Department of Aging and Disability Services. When you become eligible for Medicare, your prescription drug coverage will change from Medicaid to the Medicare Part D prescription drug program. Medicaid will still continue to pay for your other health care costs.
What does this mean for me?
You will continue to receive your prescription drugs but instead of this benefit coming from Medicaid, your coverage will shift to Medicare. This shift in coverage will occur shortly after you become eligible for Medicare.
What do I need to do?
Three months before you become eligible for Medicare, you should receive an enrollment packet, “Welcome to Medicare.” This packet will explain how to enroll in a Medicare Part D plan. Your opportunity to enroll in one of the Medicare prescription drug plans will begin when you receive the “Welcome to Medicare” packet in the mail. If, after three months, you have not enrolled in a prescription drug plan, Medicare will assign you to one. Regardless of when you enroll in Medicare Part D, you can change your prescription drug plan at any time. Medicare has a website that can help you find out the plan you’ve been assigned to if you get assigned to a prescription drug plan.
The plan Medicare assigns you to may not cover all the prescription drugs you need. The pharmacy you currently use may or may not be covered, either. Be sure to review the plan to make sure the prescriptions you rely on are covered and the plan allows you to get drugs from the pharmacy you’re used to working with. If the plan you are assigned to does not provide what you need, you will have other choices. You should review the other drug plans to find the one that best meets your needs, then, enroll in that plan. If you do nothing, your coverage will begin with the plan Medicare assigned you to. It is important to note that under Medicare Part D prescription drug coverage, you can change your plan at any time.
Will there be out-of-pocket costs?
If you have Medicare and also receive full benefits from Medicaid, you will have a small co-pay for each prescription. However, you will not have to pay monthly premiums or a deductible unless you choose and enroll in a drug plan that is more expensive than the basic-level drug plans available to you at no cost.* If you live in a nursing facility, state school, or community-based Intermediate Care Facility for the Mentally Retarded, you will have no out-of- pocket costs. Regardless of where you live, if you choose and enroll in a drug plan that is more expensive than the basic-level drug plans, you will be required to pay the difference in the cost. You will be able to choose a different prescription drug plan at any time.
*A limited number of Medicare Advantage beneficiaries who currently get their prescription drugs through Medicaid may be assigned a Medicare Part D drug plan that requires some additional out-of-pocket spending.
Which plans are "basic-level" plans?
Each year, the basic-level plans available in each state may change. The list of plans for the coming year in Texas will be updated in the fall. It's important that people with both Medicare and Medicaid review this list each fall to see if the plan they are on will be available for the coming year. If it is not, they will need to pick a new plan. If you pick a plan that is not a basic-level plan, you will have to pay a portion of the monthly premium.
Basic-level Medicare Part D prescription drug plans available in Texas
What is covered under Medicare Part D prescription drug coverage?
Medicare Part D will cover most of your necessary prescriptions. Specific information on the prescription medicines each drug plan covers will be available from the plan itself. While Medicare Part D will not cover certain categories of drugs including over-the-counter medications, barbiturates (sedatives), and benzodiazepines (anti-anxiety agents), Medicaid will continue to pay for these drugs for those who have been getting those medications from Medicaid.
Specific information on the medications each drug plan covers will be available from the plan itself.
back to top
How can I get more information?
You may receive additional information from Medicare Part D prescription drug plans in your area. You may also receive mail from companies promoting their Medicare-affiliated drug plans. It is important that you read this information carefully and make sure the drug plan you choose covers the prescription drugs you need.
In the meantime you can also:
- Visit the Texas Department of Aging and Disability Services (DADS) website
- Use the Medicare Prescription Drug Plan Finder
- Call 1-800-MEDICARE (1-800-633-4227)
- TTY users can call 1-877-486-2048