What it is
Part D is the part of Medicare that helps cover prescription drugs. It is offered through private insurance companies approved by Medicare. A standalone Part D plan is one you buy separately, without bundling it into a Medicare Advantage plan.
Medigap helps with some of the costs Original Medicare leaves behind, like certain deductibles and coinsurance. It does not pay for prescriptions. That is why people with Medigap often pair it with a separate Part D plan.
Two terms come up often. A formulary is the list of drugs a plan covers, often sorted into tiers. A pharmacy network is the group of pharmacies that have agreed to work with the plan. Both can differ from one plan to the next.
How it’s traditionally been approached
Many people start by making a list of the medicines they take now, including the dose and how often they take each one. They then check whether each plan's formulary includes those drugs. They also look at how the plan sorts them into tiers.
Next, people often look at which pharmacies are in the plan's network. Some plans have preferred pharmacies, and the cost of a drug can change depending on where you fill it. Some people also consider mail-order options.
Timing matters too. People often learn about a late enrollment penalty for going without drug coverage after they first become eligible. Many try to enroll during their first eligibility window. Plans and formularies can change each year, so many people review them during the annual enrollment period. Rules and dates can vary, so confirm current details with Medicare.gov, your State Health Insurance Assistance Program (SHIP), or a licensed agent.
How the right licensed agent may help
A Medigap agent may help you sort through Part D choices alongside your Medigap plan. A visit is usually a conversation. The agent may ask about your medicines, your pharmacy, your doctors and what matters most to you.
It can help to bring a current list of your prescriptions, with names and doses, and the name of your pharmacy. Questions you might ask include whether each drug is on the formulary, how the plan tiers it, and whether your pharmacy is in the network. You can also ask whether the plan uses prior authorization or step therapy.
You might also ask how the plan could change next year and when you can review your choice. An agent can explain options, but the choice is yours. Call 1-800-MEDIGAP for more information.
The bigger picture
Worrying about medicine costs can weigh on your peace of mind. Skipping doses or stretching a prescription because of cost can also affect how you feel day to day. Knowing your drug coverage is in place may help you feel steadier about your overall plan.
Good coverage also works best alongside good care. If you are looking for a doctor or other health professional who fits your needs, Providers.plus may be one place to explore. Take your time, and ask for help when you need it.
Keep in mind
- Medigap does not cover prescription drugs. Drug coverage comes from a separate Part D plan.
- Formularies, pharmacy networks and plan details can change, so check them again each year.
- Going without drug coverage when you are first eligible may lead to a late penalty. Confirm current rules with Medicare.gov, your SHIP, or a licensed agent.
- This page is education only, not insurance, legal, tax or medical advice. Official information is at Medicare.gov.
Medigap never includes prescription drug coverage; people pair it with a standalone Part D plan.
Licensed agents
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Frequently asked questions
Does Medigap cover prescription drugs?
No. Medigap plans do not include prescription drug coverage. People who have Medigap often add a standalone Part D plan for their medicines.
What is a standalone Part D plan?
A standalone Part D plan is a prescription drug plan you buy separately from a private insurance company. It works alongside Original Medicare and a Medigap plan. It covers drugs based on its own formulary and pharmacy network.
How do I get drug coverage with Medigap?
You enroll in a separate Part D plan. Compare plans by checking that your medicines are on the formulary and that your pharmacy is in the network. A Medigap agent may help you compare options.
How can I avoid the Part D penalty?
Generally, people try to enroll in drug coverage when they first become eligible, rather than waiting. Going without creditable drug coverage for a period may lead to a late enrollment penalty. Rules can vary, so confirm current details with Medicare.gov, your SHIP, or a licensed agent.
What is a formulary?
A formulary is a plan's list of covered drugs. Plans often group drugs into tiers, and the tier can affect what you pay. Formularies can change, so it is wise to check yours each year.
Can I keep my pharmacy with a Part D plan?
It depends on the plan. Each Part D plan has a pharmacy network, and some have preferred pharmacies. Check whether your pharmacy is in the network before you enroll.
Educational resource. 1-800-MEDIGAP shares general information and connects people with independent licensed agents. It is not professional advice. Talk with a qualified professional about your own situation.