Medicare and Medicaid: What People Living With IBD Need to Know About Coverage

When living with Crohn’s disease or ulcerative colitis, choosing the right Medicare or Medicaid plan can help make medications, specialist visits, testing, and procedures more accessible and affordable. Understanding your options and changes to coverage, can help you make informed decisions about your care and costs. 

What Should People With IBD Consider When Choosing Medicare Coverage? 

Medicare is a federal health insurance program primarily for people age 65 and older, as well as some younger people with disabilities. During Medicare open enrollment, October 15 through December 7, you can review your options and make changes to coverage for the coming year. 

There are two types of Medicare coverage: 

Original Medicare: Run by the federal government, it includes:

• Part A (hospital care)
• Part B (doctor visits and outpatient care)
• You can add a separate prescription drug plan (Part D) and supplemental insurance to help cover out-of-pocket costs.

Medicare Advantage (Part C): Offered by private insurance companies approved by Medicare. These plans cover:

• Part A
• Part B
• They often include prescription drug coverage and benefits that Original Medicare does not cover, such as dental, vision and hearing services. Benefits vary by plan. 

The Key difference: Medicare Advantage plans may have provider networks and rules about which doctors you can see. Compare costs, prescription coverage and access to your specialists to find the best fit for your IBD care. 

If you have IBD, consider these questions when comparing plans: 

• Are your providers in network? If you’re considering a Medicare Advantage plan, confirm that your gastroenterologist, specialists, hospital, and infusion center are in-network. Original Medicare generally allows you to see any provider who accepts Medicare.
• Are your medications covered? Check the plan’s formulary for your prescriptions, including biologics and other specialty medications. Some IBD treatments are covered under Medicare Part B, which generally covers certain provider-administered medications, while others may fall under Part D prescription drug coverage. Your treatment’s formulation and how it’s administered can affect coverage.
• What will you pay? Compare premiums, deductibles, copays and coinsurance for doctor visits, infusions, procedures and prescriptions. Original Medicare generally doesn’t have an annual out-of-pocket maximum for Part A and Part B services, so explore whether supplemental coverage, such as Medigap, may meet your needs. 

Learn more about Medicare coverage and health insurance options for people with IBD. 

What Medicare Changes Should You Know About for 2026 and 2027? 

Medicare’s prescription drug (Part D) deductible will increase from $615 in 2026 to $700 in 2027.  

The Part D benefit includes an annual limit on out-of-pocket costs for covered Part D medications. In 2026, that limit is $2,100. For 2027, it will increase to $2,400. Once you reach the applicable annual out-of-pocket limit, you won’t pay out of pocket for covered Part D drugs for the rest of that calendar year. 

Keep in mind that the Part D limit does not apply to every IBD treatment. For example, costs for certain infusions covered under Part B are handled differently. 

Medicare Part D plans must also offer the Medicare Prescription Payment Plan, which lets you spread eligible out-of-pocket prescription costs across monthly payments. This can help with budgeting, but it does not reduce the total amount you owe. 

Because plan costs, provider networks, and medication coverage can change, review your options each year. Visit Medicare.gov to compare plans. 

What Should People With IBD Know About Medicaid? 

Medicaid is a joint federal and state program that provides health coverage to eligible people, including some adults with low incomes and people with disabilities. Eligibility and benefits vary by state, and you can apply for Medicaid throughout the year. 

Federal changes enacted in 2025 are also scheduled to affect Medicaid in 2027, with states preparing for implementation during 2026. These include more frequent eligibility reviews for some adults and a new monthly community-engagement requirement for certain adults, generally involving 80 hours of qualifying activities. Some people, including those who are medically frail or have certain special medical needs, may qualify for an exemption. Having IBD does not automatically establish eligibility for an exemption, so check with your state Medicaid agency about how the rules apply to you. 

If you have Medicaid, keep your contact information current and respond promptly to renewal notices. Missing paperwork or deadlines can interrupt coverage and access to care.  

If you have both Medicare and Medicaid, Medicaid may help cover certain costs Medicare does not fully pay, depending on your eligibility and state program. Learn more about public health insurance options. 

Where Can You Find Help With IBD Insurance Costs? 

Taking time to review your coverage, understand upcoming changes, and ask questions can help you find options that better meet your healthcare needs and budget. 

If premiums, medications, or other care costs feel overwhelming, you’re not alone. The Crohn’s & Colitis Foundation offers insurance guidance and support resources and information about patient financial assistance programs. 

You can also contact the Foundation’s IBD Help Center for personalized guidance and help finding resources.