The Straight Answer on Medigap and Prescriptions
Medicare Supplement plans, also known as Medigap, sold since January 1, 2006, do not include prescription drug coverage [1, 2, 4, 5]. These plans are designed to help pay for out-of-pocket costs associated with Original Medicare (Part A and Part B), such as deductibles, copayments, and coinsurance [1, 2]. They do not provide coverage for medications picked up at a pharmacy [1, 2, 4].
To get coverage for prescription drugs, seniors need to enroll in a separate Medicare Part D plan [1, 2, 3, 4, 5]. These plans are offered by private insurance companies approved by Medicare [3, 4].
Medicare Part D: The Solution for Prescription Coverage
Medicare Part D is essential for seniors who need prescription drug coverage alongside Original Medicare and a Medigap plan [3, 4, 5]. It is common to have both a Medigap policy and a Part D plan [5].
How Medicare Part D Works
- Enrollment: Enrollment is required and can be done during the Initial Enrollment Period or the Annual Open Enrollment Period (October 15 - December 7) [3]. Delaying enrollment without other creditable drug coverage can result in a permanent late enrollment penalty [4].
- Costs: Costs include a monthly premium, which varies by plan, and potentially a deductible, copayments, and coinsurance [3, 4]. Starting in 2025, there is an annual out-of-pocket cap of $2,000 for covered drugs due to the Inflation Reduction Act [4, 8].
- Formulary: Each plan has a list of covered drugs called a formulary [4]. It's crucial to check if your medications are on the plan's formulary before enrolling [4, 8].
Comparing Coverage: Medigap vs. Part D
Medigap and Part D serve different, complementary roles in Medicare coverage [5].
| Feature | Medicare Supplement (Medigap) | Medicare Part D |
|---|---|---|
| Primary Purpose | Helps pay Original Medicare's out-of-pocket costs (deductibles, coinsurance) [1, 2]. | Provides coverage for prescription drugs [1, 3, 4]. |
| Prescription Drugs | No coverage for plans sold after 2005 [1, 2, 4, 5]. | Primary coverage for retail prescription medications [1, 3, 4]. |
| How It's Offered | Sold by private companies; standardized plans [1, 2]. | Sold by private companies as standalone plans or part of Medicare Advantage [3, 4]. |
| Works With | Original Medicare (Part A & B); cannot be used with Medicare Advantage [2, 6]. | Original Medicare, Medigap plans, and some Medicare Advantage plans [5]. |
| Key Benefit | Reduces unpredictable medical bills from hospital stays and doctor visits [2]. | Lowers the cost of necessary medications and provides protection against high drug costs [4, 8]. |
The 'Old' Medigap Plans with Drug Coverage
Some older Medigap plans (Plans H, I, or J) purchased before 2006 included basic drug coverage and are no longer sold to new enrollees [2]. Individuals with these plans can keep them but cannot also enroll in a Part D plan for drug coverage [2, 8]. The drug coverage in these older plans is often less comprehensive than modern Part D plans [2].
Conclusion: Building Your Complete Coverage
Modern Medicare Supplement plans do not cover prescriptions for seniors. They are designed to manage Original Medicare's cost-sharing [1, 2]. To cover prescription drugs, a separate Medicare Part D plan is necessary [1, 3, 4]. Combining Original Medicare, a Medigap policy, and a Part D plan provides comprehensive coverage and financial predictability [5]. The official Medicare website offers tools to find Part D plans [8].
