What it is
Medicare Part D is prescription drug coverage. It is sold by private insurance companies approved by Medicare. You can get it as a stand-alone plan alongside Original Medicare.
Medigap, also called Medicare Supplement Insurance, is a different kind of coverage. It helps pay some of the costs Original Medicare leaves behind, such as certain deductibles, copays and coinsurance. Medigap plans sold today do not include prescription drug coverage.
So the two work side by side. Original Medicare covers hospital and medical care. Medigap may help with cost-sharing. A separate Part D plan may help with drugs. Each one has its own enrollment, its own plan and its own rules. Official details are at Medicare.gov.
How it’s traditionally been approached
Many people with Medigap have built their coverage in layers. They start with Original Medicare Parts A and B, add a Medigap plan such as Plan G or Plan N, and then add a stand-alone Part D plan.
Part D plans differ from one another. Each has a formulary, which is its list of covered drugs. Plans may also differ in pharmacy networks, how drugs are grouped into tiers and what you pay at the counter. Because these details can change from year to year, people have traditionally reviewed their plan during the annual fall enrollment period.
Older Medigap policies sold years ago sometimes included drug coverage, but that is no longer the case for plans sold today. Medigap plan letters are standardized in most states, though Massachusetts, Minnesota and Wisconsin standardize Medigap differently. Plans C and F are available only to people who became eligible for Medicare before January 1, 2020. Plans E, H, I and J were discontinued and are not sold today. If you are searching for Plan H, that is why it is hard to find.
How the right licensed agent may help
A Medigap agent is a licensed professional who may be able to explain how a Medigap plan and a Part D plan could fit together for you. Some agents also help with Part D plans. A good conversation often starts with a simple question: what do you take, and where do you fill it?
A visit or call is generally relaxed. The agent may ask about your doctors, your current medications, your pharmacy and your budget comfort. They may then walk through which plans are available where you live and explain the differences in plain language. Agents are not a substitute for Medicare.gov or your State Health Insurance Assistance Program (SHIP), and you can use all three.
Helpful questions to ask: Is each of my medications on the plan's formulary? Is my pharmacy in the network? How does the plan handle coverage in each stage of the year? When can I change plans? Are there rules in my state that affect Medigap enrollment? Call 1-800-MEDIGAP for more information.
The bigger picture
Prescription costs can weigh on the mind. When you take medicine every day, knowing how it will be covered can bring real peace of mind. Feeling unsure about the pieces of your coverage can add stress, so taking time to understand them is a caring step for your well-being.
Good health is about the whole person, not only the paperwork. Once your coverage feels settled, you can put more energy into the things that matter, like staying active, seeing your doctors and enjoying time with family. If you are also looking for care providers, Providers.plus may be a helpful place to start.
Keep in mind
- Medigap plans sold today do not cover prescription drugs, so a separate Part D plan is generally needed.
- Medicare Advantage is a different path. Many of its plans include drug coverage, often with lower premiums, an annual out-of-pocket maximum and extra benefits, but they use networks and may require prior authorization. Medigap offers any provider nationwide that accepts Medicare and predictable cost-sharing, but it generally has higher monthly premiums and no routine dental, vision or hearing. Neither is right for everyone.
- Enrollment windows, guaranteed issue rights, and underwriting rules vary by state and change over time. Confirm current rules with Medicare.gov, your SHIP or a licensed agent.
- If you go without creditable drug coverage when you are first eligible, a late enrollment penalty may apply. Check Medicare.gov for the current rules.
Take the next step
- Talk with a Medigap agent ↗Jeff Cline on contacts.plus — a person, not a call center.
Not sure where to start? Answer a few gentle questions and choose who you’d like to hear from.
Call 1-800-MEDIGAP for more information
Frequently asked questions
Can I have Medicare Part D with Medigap?
Yes, you can have Medicare Part D with Medigap. In fact, most people who have Medigap add a separate Part D plan for prescription drugs. The two are bought separately and work side by side with Original Medicare.
Does Medigap cover prescription drugs?
No, Medigap plans sold today do not cover prescription drugs. Medigap helps with certain Original Medicare cost-sharing instead. A stand-alone Part D plan is the usual way to add drug coverage.
Do I need Part D if I have Medigap Plan G?
Plan G does not include drug coverage, so you would generally need a separate Part D plan if you want help with prescriptions. Going without drug coverage can sometimes lead to a late enrollment penalty. Review the current rules at Medicare.gov or with a Medigap agent.
Can I get Part D and Medigap from different companies?
Yes, they are separate policies and may come from different insurance companies. Many people do this. Each plan has its own premium, rules and enrollment steps.
When can I enroll in Part D if I have Medigap?
You can generally join when you first become eligible for Medicare and during the annual fall enrollment period. Some special situations may open other windows. Confirm current timing with Medicare.gov, your SHIP or a licensed agent.
Is Medicare Part D with Medigap better than a Medicare Advantage plan with drug coverage?
Neither is better for everyone. Medigap with Part D offers any provider nationwide that accepts Medicare and predictable cost-sharing, but usually costs more each month and does not include routine dental, vision or hearing. Medicare Advantage often has lower premiums, an out-of-pocket maximum and extra benefits, but uses networks and may require prior authorization. Call 1-800-MEDIGAP for more information.
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.