What Medigap plans cover prescription drugs? This is a common question, especially for those managing regular medications. Most Medigap plans focus on costs like copayments, coinsurance, and deductibles, but they don’t include drug coverage at the pharmacy. Many years ago a few Medigap plans covered prescription drugs but those plans are no longer available. If you need prescription coverage, there are ways to add Rx coverage while keeping your Medigap plan.
What medications can I get at the pharmacy with my Medigap plan?
Medigap and Original Medicare don’t cover prescriptions you pick up at the pharmacy, though they do cover certain life-saving drugs you might need in the hospital. To get prescription coverage at the pharmacy, most people with Medigap add a separate Medicare Part D plan. Medigap is private insurance that helps with costs Original Medicare doesn’t cover, like co-pays, deductibles, and coinsurance—but prescriptions aren’t included.
So, if you want pharmacy coverage and have Medigap, you’ll need to look into a stand-alone Part D drug plan. The other option is to leave your Medigap plan and enroll in a Medicare Advantage plan that includes prescriptions. If you need help, call our team here at Senior65.com at 800-930-7956. This is a free service to you.
What is Medicare Part D?
Medicare Part D is a federal program that gives people on Medicare the option to add prescription drug coverage. Private insurance companies run these plans, giving you access to certain medications at low or even zero cost. Part D plans can help pay for prescriptions you pick up at the pharmacy or order by mail, but each plan has its own list of covered drugs, monthly premium, deductible, and copay structure. Learn more about Medicare Part D Drug and get a quote here.
How much will Medicare Part D cover for my prescriptions?
Medicare Part D has a few phases, kind of like levels in a video game. Basically, the amount you pay for each drug changes depending on the “phase” you’re in. Starting in 2025, here’s how the three phases will work:
1. Annual Deductible Phase
In 2025, there’s a $590 deductible for Medicare Part D. This means you’ll pay the first $590 of your drug costs before your insurance kicks in. Some plans may still waive this deductible for generic drugs.
2. Initial Coverage Phase
After meeting your deductible, you’ll enter the “initial coverage” phase, where you’ll pay 25% of your drug costs. This continues until you hit a $2,000 limit. So, even after the deductible, you’ll still share some of the costs.
3. Catastrophic Coverage Phase
Once you’ve spent $2,000 out-of-pocket, you move to the catastrophic phase. Here, you’ll pay almost nothing for your medications for the rest of the year, with most of the cost covered by Medicare and your plan. It used to be 5%, but now costs are even lower or zero for most drugs.
What’s next?
If you want to sign up for a Part D plan, use this self-serve link to enter your medications, compare prices, and enroll online. Remember, we don’t offer every plan in your area. The info we provide is only about the plans we do offer. For a complete list of options, visit Medicare.gov or call 1-800-MEDICARE.