Do Medicare Supplement (Medigap) Plans Cover Prescription Drugs?
This article was updated on: 09/16/2018
As you may already know, there’s only limited prescription drug coverage under Original Medicare, Part A and Part B. Part A may cover medications given to you as part of your inpatient treatment in a hospital. Part B may cover some medications administered to you as an outpatient. Medicare Supplement plans don’t usually cover prescription drugs, but they may cover some of Original Medicare’s out-of-pocket expenses.
What does a Medicare Supplement plan cover?
If you’re currently enrolled in Original Medicare, you may have heard that Medicare Supplement plans can help with certain costs. Medicare Supplement insurance is designed to complement Original Medicare. Original Medicare provides a lot of coverage for medical care, especially if you have Medicare Part A (hospital insurance) and Part B (medical insurance). However, it doesn’t cover everything.
Medicare Supplement plans are offered by private insurance companies and can help you pay for out-of-pocket costs not covered under Original Medicare. Medicare Supplement (also known as Medigap) plans fill the “gaps” in Original Medicare coverage. These “gaps” are the costs you’re responsible for — such as deductibles, coinsurance and copayments — under Original Medicare. Some Medicare Supplement plans may offer additional innovative benefits (such as discounts on eyeglasses and contact lenses or health club discounts, for example). However, not every plan offers these benefits, so it’s a good idea to check which plans are available in your area.
You can apply for a Medicare Supplement plan from any insurance company that is licensed in your state to sell one and offers plans available in your area.
How do I get Medicare prescription drug coverage?
The government doesn’t allow Medicare Supplement policies sold after January 1, 2006, to include Medicare prescription drug coverage. So if you want to have Medicare prescription drug coverage (Part D), you have two options:
- If you have Original Medicare, you can enroll in a stand-alone Medicare Prescription Drug Plan (PDP). Designed to work alongside Original Medicare coverage, Medicare Prescription Drug Plans are available from private insurance companies approved by Medicare and doing business in your state of residence. A Medicare Prescription Drug Plan can help with certain prescription drug costs not covered by Part A and Part B, although you may still be responsible for premiums, copayments, and coinsurance costs.
To enroll in a Medicare Prescription Drug Plan, you must have Medicare Part A and/or Part B and live in the service area of a Medicare Prescription Drug Plan. You will need to pay your monthly Part B premium, in addition to your monthly Medicare Prescription Drug Plan premium (unless your premiums are covered because you receive Extra Help). Medicare Prescription Drug Plans cover different prescription drugs; they can also vary when it comes to cost sharing (the amount you pay for the prescription) and premiums for coverage. It is a good idea to compare Medicare Prescription Drug Plans in your location to find plan options that may work best for you.
You cannot have a Medicare Supplement plan with prescription drug coverage (purchased before January 2006) and a Medicare Prescription Drug Plan (PDP) at the same time. If your Medicare Supplement plan covers prescription drugs and you decide to enroll in a Medicare Prescription Drug Plan, make sure to let your Medicare Supplement insurance company know. Your Medicare Supplement plan can remove prescription drug coverage from your Medicare Supplement plan and adjust your premium if needed. Keep in mind that once you drop your Medicare Supplement plan’s prescription drug coverage, you can’t change your mind and get this coverage back. However, you can make changes to your Medicare Prescription Drug Plan (such as switching plans or dropping your prescription drug coverage) during certain times of the year or in special situations.
- Another option is to enroll in a Medicare Advantage plan that includes Medicare prescription drug coverage (also referred to as a Medicare Advantage Prescription Drug plan, or MAPD). Like stand-alone Medicare Prescription Drug Plans, Medicare Advantage plans are offered by private insurance companies that contract with Medicare and are available through “Part C” of the program. Medicare Advantage plans must provide at least the same level of coverage as Original Medicare (with the exception of the hospice benefit, which is covered by Part A). Many Medicare Advantage plans include prescription drug coverage, but not every plan does, so always check with the specific plan. If you decide to get your Medicare benefits through a Medicare Advantage plan, you can generally get prescription drug benefits through your plan, if available, or with a stand-alone Medicare Prescription Drug plan if the Medicare Advantage plan doesn’t include prescription drug coverage.
To find out if a Medicare plan covers your medications, you can check the plan’s formulary, or list of covered drugs. Keep in mind that the formulary may change at any time. If needed, you will receive notice from your plan. Like stand-alone Medicare Prescription Drug Plans, Medicare Advantage Prescription Drug plans differ when it comes to covered drugs, cost-sharing amounts, and premiums. By taking the time to compare plans available where you live, you may find a plan option that covers your prescription drugs at the best value.
Keep in mind that if you enroll in a Medicare Advantage plan and have Medicare Supplement insurance, you can’t use your Medicare Supplement plan to pay for costs you may have with your Medicare Advantage plan. Medicare Supplement plans only work with Original Medicare. You may want to consider canceling the Medicare Supplement plan if you decide to enroll in a Medicare Advantage plan, since you’ll otherwise be paying for benefits you can’t use. If your Medicare Supplement plan included prescription drug coverage, you may want to select a Medicare Advantage plan that offers Medicare prescription drug coverage if available.
How can I learn more about Medicare Supplement plans and prescription drug coverage?
Hopefully, you now have a better understanding of how Medicare prescription drug coverage works when it comes to Medicare Supplement coverage. If you want to learn more about your Medicare coverage and options, I can help you find Medicare plan options that may fit your prescription drug needs.
- You can use one of the links below to set up a phone call with me or request personalized information from me by email.
- You can also do some research on your own to get familiar with Medicare plan options in your area by clicking on the Compare Plans button on this page.
The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company.
Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the Federal Medicare program.