One of the most common questions Medicare beneficiaries ask is whether prescription drugs are included with Medicare Supplement plans. This Medicare Supplement agency in Wanatah, Indiana is going to answer that question below.

Prescription drug coverage requires a separate Part D plan.

Medicare Supplement (Medigap) plans are supposed to fill the gaps in Original Medicare. These standardized policies cover some of the leftover costs that Original Medicare does not fully cover, like coinsurance and deductibles. What Medigap does not do is add new benefits that Medicare never covered in the first place.

Original Medicare generally does not cover routine dental care, routine vision exams or hearing aids in the first place. Because Medigap supplements only Medicare-covered services, it can’t expand into those routine benefits.

The same principle applies to prescription drugs. Medigap policies do not include outpatient prescription drug coverage. Some older policies had limited drug benefits years ago. But since Medicare Part D rolled out in 2006, prescription drug coverage has been handled separately.

Medicare prescription drug coverage is provided through Medicare Part D. These plans are sold by Medicare-approved private insurance companies. If you have Original Medicare and a Medigap plan, you may want to enroll in a stand-alone Part D to handle your medications.

​​Each Part D plan has its own list of covered drugs or formulary. That list can change from year to year. Plans also place medications into different tiers and the tier affects how much you pay at the pharmacy.

On top of that, each plan sets its own monthly premium and works with its own network of pharmacies. Many plans have preferred pharmacies where your costs are lower and standard pharmacies where you’ll have to pay more. Some medications also require prior authorization or step therapy before they are covered.

So, the best plan for your neighbor may not be the best plan for you. The best plan depends on the prescriptions you take and where you prefer to fill them.

If you don’t enroll in Part D or have other creditable prescription drug coverage, you will generally be paying the full price for your prescriptions. And those prices can be hefty.

Medicare does recognize that some people have other drug coverage through an employer plan, a union plan, VA benefits or similar programs. If that coverage is considered creditable (i.e., it is expected to pay at least as much as standard Medicare drug coverage), you may be able to delay Part D without penalty. Keep documentation of that creditable coverage in case you need it later.

This is where you would benefit from having a Medicare Supplement agency in Wanatah, Indiana on your side. An experienced agent can review your prescriptions and compare the available Part D plans to help you pick the best plan.

What if you don’t enroll in Part D when you have Medigap?

If you choose not to enroll in Part D when you are first eligible and you do not have other creditable prescription drug coverage, Medicare can charge a late enrollment penalty. This penalty is added to your monthly Part D premium and generally lasts for as long as you have Medicare drug coverage. The longer you go without coverage, the bigger that penalty can grow.

Timing is an important piece of the puzzle. Your Initial Enrollment Period is limited. After that window closes, you may have to wait until the Annual Enrollment Period to enroll in a Part D plan. Unless you qualify for a Special Enrollment Period, you could be stuck without drug coverage until then. During that time, you would be paying out of pocket for prescriptions.

An experienced Medicare Supplement agency in Wanatah, Indiana can help you coordinate your enrollment dates, so your Medigap and Part D coverage start together.

Looking for a Medicare Supplement agency in Wanatah, Indiana?

If you want to learn more about Part D, you can always get in touch with a licensed Medicare Supplement agency in Wanatah, Indiana. Our licensed agents at Senior Care Insurance Services (SCIS) can explain how Medigap and Part D fit together and even help you enroll. Contact us today to schedule a free consultation with our team.