Why $0 Prescriptions on Medicare Dual Plans Went Away

There are a lot of other seniors like you who are in a Medicare dual plan and find that they have to pay co-pays for prescription medications in 2026. A lot of people who used to get free medicines are now having to pay extra for them. What actually happened? What happened to the $0 prescriptions that came with Medicare dual plans? What can you do to keep your out-of-pocket costs as low as possible going forward?

There used to be no prescription costs for Medicare dual plans, but now there are co-pays. We will talk about why this happened and how you can minimize your prescription drug costs in the future.

How $0 Prescriptions on Medicare Dual Plans Were Possible in the Past

A few years ago, Medicare dual beneficiaries (people who are eligible for both Medicare and Medicaid) did not have to pay any co-pays for their prescriptions. How did this take place?

The important part of this benefit was giving Medicare Advantage providers refund money. Between 2021 and 2025, insurance got more money from refunds than at any other time in history. For medicare dual plans eligible members, these funds allowed insurance companies to reduce the co-pays for medications to zero. The refunds came from a number of places, such as Medicare Advantage star grades and risk adjustment models that were more favorable, which gave insurers more money.

Because of these good conditions, insurers had to use the extra return money to lower the costs for members, such as paying for all of their medicines. Due to a perfect storm of budget surpluses, dual eligible members enjoyed free medications for a few years in addition to the law.

What Changed in 2026?

In 2026, the $0 prescription benefit for most dual eligible Medicare Advantage plans was reduced or eliminated. The reason? Inflation Reduction Act (IRA) provisions.

The Inflation Reduction Act (IRA) and its Impact

The Medicare Part D prescription drug plan changed a lot when the IRA was passed in 2022. The way the costs were split changed, and it was one of the most important changes:

• Before IRA: When a Medicare user reached catastrophic coverage, which means their prescription costs went over a certain limit, Medicare and drug companies would pay for most of the remaining costs.
• After IRA: The responsibility for covering costs shifted, with insurers now required to cover a more significant portion of prescription drug costs, especially when catastrophic coverage kicks in.

Because of this change, insurance had to pay more of the costs, so they had to cut back on extra perks like drug co-pays that were free. Because they did not have as much extra money to pay for medication costs, Medicare Advantage plans started charging dual eligible beneficiaries co-pays again.

Why Did Insurers Eliminate the $0 Prescription Benefit?

The key reasons for this shift in policy are as follows:

Increased Financial Liability for Insurers

When the IRA changed the way costs were spread, Medicare Advantage insurers were left with more debt. To make up for this, insurers started reducing the medicare dual plans benefits they had been giving out under the $0 drug co-pay plan.

Less Funding and Reduced Rebates

As the amount of refund money (rebate dollars) went down, insurance could no longer afford to offer these extra benefits. The refunds that used to help bring down the cost of prescriptions to zero were not enough to keep these full benefits of medicare dual plans going.

A Changing Policy Landscape

With the termination of the $0 prescription on medicare dual plans or benefits, many dual-eligible beneficiaries who had previously enjoyed free prescriptions are now seeing co-pays for the first time in years. This reflects a broader trend of cost-shifting within the Medicare program to make sure it can last for a long time.

What Can You Do to Lower Your Prescription Costs?

Though the $0 prescription on medicare dual plans have largely ended, there are still ways to manage and reduce your prescription costs in 2026.

Apply for Extra Help

Extra Help is a Social Security program that helps lower prescription drug costs for people with limited income. Even though $0 prescriptions on medicare dual plans are no longer the standard, Extra Help can cap your costs, making medications more affordable. If you’re dual eligible, you likely qualify for Extra Help, which can limit your out-of-pocket costs:

• Generics: Up to $5.10 per prescription 
• Brand Name Drugs: Up to $12.65 per prescription.

Use a Medicare Broker or Medicare.gov

Working with a Medicare broker like LMS Insurance Group can help you find the best plan that covers your medications at the lowest cost. You can also visit Medicare.gov and enter your prescription list to compare plans. This tool will show you the plans that cover your drugs at the most favorable rates, sometimes even at $0 for certain medications.

Manufacturer Assistance Programs

For people with low incomes, including dual eligible beneficiaries, many drug companies offer patient assistance programs. You might be able to get free or affordable medications straight from the drug companies if your income is less than 400% of the government poverty level.

Switch to a Plan with Better Prescription Coverage

Not all Medicare Advantage plans are the same. Some plans may still offer $0 prescriptions or low-cost alternatives for certain medications. Be sure to review your options during Open Enrollment and select a plan that better aligns with your prescription needs.

Final Call

Because of changes in policy and costs caused by the Inflation Reduction Act, Medicare dual plans will no longer cover medications for free starting in 2026. Dual-eligible recipients can not get free medications anymore, but there are still ways to lower the cost of drugs, like Extra Help, Medicare.gov tools, and manufacturer assistance programs.

If the cost of your prescriptions is going up, now is the time to look at your choices, see if there is any help that is available, and find the best plan for your needs. In spite of changes, there are still ways to lower your out-of-pocket costs and make sure you get the medicines you need.

At LMS Insurance Group, we help dual-eligible holders find the best Medicare plans that work for them. We can help you if you are having a hard time with rising medication costs or if you have questions about your plan choices. We can help you figure out these changes and find the best Medicare Advantage plan for your needs. Contact us today for a free appointment.