Do Medigap Plans Cover Drugs? Insurance Coverage for Prescription Drugs
If you are new to Medicare, it’s no secret that prescription drugs can be expensive. If you’re enrolled in Original Medicare coverage, you may be wondering if supplemental insurance, like Medigap, can help cover the cost of your medications. Keep reading to find out more.
Table of Contents
Does Medigap Cover Prescription Drug Coverage?
No, Medicare supplement plans do not cover your Part D prescription drugs obtained from your local pharmacy. You will need to enroll in a stand-alone prescription drug plan (Part D) to get coverage for the medications prescribed by your doctor.
What are Medigap Policies?
Medigap is a type of health insurance that helps cover certain out-of-pocket costs not covered by Original Medicare. These costs can include Medicare Part A & Part B coinsurance, copayments, and deductibles.
Medicare supplemental plans are offered by private insurance companies and are only available to people enrolled in Medicare.
There are ten different types of Medicare supplement insurance plans, each with a different set of benefits.
Medicare beneficiaries who learn the difference between Medigap plans and Medicare Advantage plans prefer staying on Original Medicare and buying a Medigap plan.
We have found more than eighty percent of our clients have opted for a Medicare supplement plan when they are presented with the facts comparing the differences.
As long as you continue to pay your premium each month insurance companies are unable to cancel your Medicare supplement policy.
What is the difference between a Medicare Advantage Plan and a Medigap Plan?
The main difference between a Medicare Advantage Plan and a Medigap Plan is that a Medigap plan works alongside Original Medicare by filling in the gaps in coverage and a Medicare Advantage Plan replaces Original Medicare.
Medicare Advantage plans typically include prescription drug coverage as part of their plan, with a Medicare supplement plan you can obtain a standalone Part D plan.
Both types of plans have their pros and cons, but ultimately it comes down to what your specific needs are. When considering a Medicare plan it is important to review what Medicare doesn’t cover and how each plan you are considering would work for you.
We wrote an extensive article on this topic if you would like to go more in-depth. Click here to learn more: What is the Difference Between Medicare Advantage Plans vs Medicare Supplements?
Medicare Part D
The Centers for Medicare & Medicaid Services (CMS) handle the Medicare Part D program. Part D is the prescription drug benefit that is available to Medicare beneficiaries and sold by private insurance companies.
You can receive this benefit through a stand-alone prescription drug plan (PDP) or a Medicare Advantage plan (like an HMO or PPO) that offers Part D prescription drug coverage. If you have other insurance coverage, like employer-sponsored insurance or TRICARE, you can choose to have that coverage instead of Medicare Part D.
When you enroll in a Medicare Part D plan, you will be asked to pay for prescription drugs premium either monthly, quarterly, or in full. You will also be responsible for a deductible, and then you will pay a copay or coinsurance for your prescriptions.
Each Medicare Part D plan has its own formulary or list of covered drugs. Some drugs may require prior authorization before your plan will cover them.
If you need help paying for your Medicare Part D premiums and other out-of-pocket costs, you may be eligible for the Extra Help program. This program is run by the Social Security Administration, and it can help you pay for your Part D premiums, deductibles, and coinsurance.
If you have Medicare Part A and/or Part B, you may enroll in a Medicare Part D plan during the Initial Enrollment Period. This period starts three months before the month you turn 65, includes the month you turn 65 and ends three months after the month you turn 65.
You may also enroll during the yearly Open Enrollment Period, which runs from October 15 to December 7. If you are already enrolled in a Medicare Advantage plan, you can switch to a different Medicare Advantage plan or switch to a Medicare Part D plan during the yearly Open Enrollment Period.
If you qualify for a Special Enrollment Period, you can enroll in a Medicare Part D plan outside of the Open Enrollment Period. Special Enrollment Periods are available for certain situations, like if you move or if you lose other prescription drug coverage.
You can find more information about Medicare Part D and how to enroll on the CMS website. You can also contact one of our licensed insurance agents who specialized in Medicare Part D plans, Medicare supplement plans, and Medicare Advantage plans.
Medicare Part D Late Enrollment Penalties
If you go without a Medicare Part D prescription drug plan when you’re first eligible, you may have to pay a late enrollment penalty. The penalty is calculated based on the number of months you didn’t have coverage and is added to your premium.
The calculated penalty will be in addition to the standard monthly Part D premium for the remainder of your life. You may be able to avoid the penalty if you can show that you had other creditable prescription drug coverage through an employer plan, VA healthcare, or Tricare.
Finding Part D Medicare Plans
When looking for a Part D plan it is best to talk with experienced Medicare insurance brokers. They understand that there are many factors that go into finding the cheapest Part D plan outside of the lowest monthly Part D premium.
When obtaining prescription drug coverage quotes, it is important for your insurance agent to have the following information:
- List of all Prescription Drugs
- Dosage of each prescription medication
- How often do you take each prescription
- Are you open to generic replacement brands
Armed with this information we can quickly locate the best Part D prescription drug plan in your local area.
Medicare Part D Costs
– Medicare Part D is a prescription drug coverage plan that is available to Medicare beneficiaries.
– Part D plans are offered by private insurance companies and cover both brand-name and generic drugs.
– There is a monthly premium for Part D coverage, and beneficiaries may also be responsible for a deductible, copayments, and coinsurance.
– Part D plans have a coverage gap or “donut hole,” during which beneficiaries are responsible for the full cost of their prescriptions.
Part D costs can vary depending on the specific plan you choose, but all plans must offer at least some basic level of coverage. The monthly premium for Part D coverage will be determined by your chosen plan, and you may also be responsible for a deductible, copays, and coinsurance.
During the coverage gap or “donut hole,” you will be responsible for the full cost of your prescriptions. However, there are ways to save money on Part D costs, such as through discounts and coupons offered by pharmaceutical companies.
Medicare Part D and Medigap
Medicare Part D is a prescription drug benefit that helps cover the costs of prescription drugs. Medigap is a supplemental insurance policy that can help cover the costs of Medicare Part A and Part B deductibles, coinsurance, and copayments.
What types of Insurance Plans are Available?
There are two types of insurance plans available: Original Medicare and Medicare Advantage. Medicare Advantage plans are offered by private insurance companies and can include additional benefits than being offered by Original Medicare. However, they may have higher premiums and out-of-pocket costs.
Original Medicare (Parts A and B) does not cover most prescription drugs. However, you can add drug coverage to your Original Medicare plan by enrolling in a stand-alone Part D prescription drug plan or a Medicare Advantage plan with prescription drug coverage.
If you have a Medigap policy, it will not cover prescription drugs. However, some Medigap plans offer coverage for some preventive services, such as vaccinations.
How to Pay for Drugs With Medicare
Part A and Part B Coverage of Prescription Drugs
Part A and Part B of Medicare both cover prescription drugs when they are administered at a hospital or doctor’s office.
Prescription drug coverage is not covered by Part A or Part B when picked up at your local pharmacy.
Employer and Union Prescription Drug Coverage
If you’re covered by a union or employer group health plan, you may be able to get help with the costs of your prescription drugs. These plans are sometimes called “Section 125” or “cafeteria” plans.
You may be able to pay for part of your monthly premium and other out-of-pocket costs with pretax dollars.
This can save you money on your taxes. Employer and union prescription drug coverage is different from Medicare prescription drug coverage (Part D). If you have this kind of coverage, you don’t need to enroll in a Medicare drug plan.
VA Health Care Benefits
If you are a qualified veteran who receives benefits from a VA facility, the prescription drug coverage offered by the VA is considered creditable coverage. In this case, you do not need to pay for any additional Part D coverage unless you are wanting additional prescription drug options.
What is the difference between Parts A and B?
Part A of Medicare is hospital insurance that helps pay for inpatient care in a hospital or skilled nursing facility (following a hospital stay), some home health care, and hospice care.
Part B of Medicare is medical insurance that helps pay for doctors’ services, outpatient care, home health care, durable medical equipment, and some preventive services.
What is the difference between Parts C and D?
Part C of Medicare is also known as Medicare Advantage. This is a type of Medicare plan that is offered by private insurance companies. Part C plans must offer at least the same coverage as Original Medicare (Parts A and B), but some plans may offer additional benefits, such as prescription drug coverage.
Part D of Medicare is the prescription drug coverage part. This coverage is offered by private insurance companies and is available to anyone who has Medicare Part A or Part B, regardless of whether they have a Part C plan.
How do I enroll in a Medigap plan?
Enrolling in a Medigap plan is simple. You can enroll through a Medigap agent or by contacting the insurance company directly. You’ll need to provide some basic information, like your name, address, date of birth, and Social Security number.
You may also need to provide information about your current health insurance coverage.
How do I compare Medigap plans?
There are 10 standardized Medigap plans available in most states, each with a different set of benefits. When you compare Medigap plans, you’ll want to consider the following:
- The monthly premium
- The deductible
- The coinsurance
- The out-of-pocket limit
- The coverage for prescription drugs
- The coverage for foreign travel
- The coverage for preventive care
- The coverage for routine vision, hearing aids, and dental care
You’ll also want to consider the company’s financial stability, customer service, and reviews from other policyholders. Medicare supplement plans C and F are no longer available to newly eligible Medicare beneficiaries after January 1, 2020.
Medicare Supplement plans are standardized Medicare plans which means the plans do not change from year to year like a Medicare Advantage plan.
What are the benefits of enrolling in a Medigap plan?
Medigap plans are an affordable way to help cover the cost of Medicare deductibles, coinsurance, and copayments. In addition, some Medigap plans offer coverage for prescription drugs.
The benefits of enrolling in a Medigap plan include the following:
- Help pay for Medicare deductibles, coinsurance, and copayments
- No surprise bills
- Some plans offer coverage for foreign travel emergency care
- Some plans offer extra benefits, such as vision or hearing coverage
- Plans are standardized
- Medical needs are easily budgeted
- Not tied to a network of doctors
- No referral required
- No pre-authorizations
- Your Doctor is in control of your medical needs, not the insurance company
It is vital to buy Medigap coverage during your Medicare supplement open enrollment period. This will ensure you can obtain a Medigap policy without medical underwriting. During your guaranteed enrollment period Medicare companies must accept an enrollee regardless of your health conditions
Enrolling in a Medigap plan is a great way to help cover the costs of Medicare. Be sure to compare plans and rates before enrolling to find the best coverage for your needs.
Tips for Choosing a Part D Plan
There are a few things to keep in mind when choosing a Part D plan for your Medigap coverage. First, make sure that the plan you choose covers the drugs you need. There are many different Part D plans available, and each has its own list of covered drugs.
Second, consider the costs of the plan. Part D plans have a monthly premium, as well as a deductible and copayments for covered drugs. Make sure you can afford the plan you choose.
Finally, consider the convenience of the plan. Part D plans are offered by private insurance companies. Some plans may be more convenient than others, depending on your location and the pharmacies you use.
Choosing a Part D plan is an important decision. Make sure to do your research to find a plan that is right for you.
How do I apply for Medicare Prescription Drug Plans?
There are two ways to get drug coverage under Medicare. You can join a stand-alone Medicare Prescription Drug Plan (Part D) or you can get this coverage as part of a Medicare Advantage Plan (Part C).
You can join a Medicare Prescription Drug Plan when you first become eligible for Medicare. You can also join during the Annual Enrollment Period (October 15 to December 7).
If you have Medicare Advantage, you can switch to a stand-alone Medicare Prescription Drug Plan during the Annual Enrollment Period, but you will need to disenroll from your Medicare Advantage Plan.
When buying a Medicare Prescription Drug Plan, make sure you talk with an insurance agent who specializes in Medicare. They will ensure you are selecting the best plan that will provide the most coverage at an affordable price.
Things to know before you shop
Avoid the PDP Late-enrollment Penalty
If you don’t enroll in a health insurance plan during the open enrollment period, you may have to pay a late-enrollment penalty. The late-enrollment penalty is a fee that you’ll have to pay for each month that you’re not enrolled in a health insurance plan.
The fee is calculated based on the number of months you were uninsured and the national average premium for the lowest-cost Bronze plan available in your area.
Save more at Preferred cost-sharing Pharmacies
Preferred cost-sharing pharmacies usually charge lower prices for prescription drugs than non-preferred pharmacies. This can help you save money on your prescriptions. However, there are a few things to keep in mind before you shop at a preferred cost-sharing pharmacy:
- Make sure the pharmacy is in your insurance plan’s network.
- Check if the pharmacy offers the prescriptions you need.
- Find out if there are any restrictions on using the pharmacy, such as only being able to use it for certain types of drugs.
If you keep these things in mind, you can save money by using a preferred cost-sharing pharmacy for your prescriptions.
How Do I know If my Plan is Considered Creditable Drug Coverage
To find out if your plan is considered creditable prescription coverage, you need to reach out to your employer benefits administrator or plan sponsor. You can also find out if your plan is creditable by looking for a notice from your health care plan that says it meets the criteria for creditable drug coverage.
Part D or Creditable coverage is defined as any prescription drug coverage that is at least as good as the standard drug coverage under Medicare Part D.
If you’re enrolled in a Medicare Advantage plan, you’re already getting prescription drug coverage that meets the standards set by Medicare. So, you don’t have to worry about whether or not your plan is considered creditable.
If you have a Medicare Supplement insurance plan, you may also have prescription drug coverage that’s considered creditable.
Talk to a Licensed Insurance Agent Specializing in Everything Medicare
When it comes to finding a qualified insurance agent who specializes in Medicare, you want to be sure that you take the time to find someone who is truly an expert in the field.
There are a lot of insurance agents out there who may claim to be experts in Medicare, but the truth is that many of them are not.
This is why it is so important to find an agent who is licensed and who has a wealth of experience in dealing with Medicare.
Integrity Now Insurance Brokers is an independent insurance agency that caters to the senior community. We have spent years developing this site to empower our clients to learn as much as possible about Medicare.
As new issues come up, we do our best to research the topic and add new relevant articles answering some of the most common and complicated questions we come across.
We are here to help you obtain plans sold by an insurance company. As premiums vary by insurance providers we have done our best to represent most of the major insurance companies as possible.
Reach out to us today and see how we can improve your Medicare benefits.
