Medicare Supplement

Santa Clarita readers: why a Medigap policy needs a Part D plan beside it

SANTA CLARITA, Calif. — If you're moving from an employer plan to Original Medicare, it's easy to assume a Medigap (Medicare Supplement) policy handles everything. It doesn't. Medigap helps with the out-of-pocket costs Original Medicare leaves behind — things like coinsurance and copays under Part A and Part B. It does not pay for the pills you pick up at the pharmacy.

The three pieces, and why Medigap alone isn't enough

To get drug coverage with Original Medicare and Medigap, you add a third piece: a stand-alone Medicare Part D prescription drug plan. Think of it as a three-legged stool — Original Medicare (Parts A and B), a Medigap policy, and a Part D plan.

Santa Clarita is in Los Angeles County, where a wide range of stand-alone Part D plans is sold each year. Availability is set at the county level, so your options in Santa Clarita are the same as elsewhere in Los Angeles County.

Why Medigap doesn't include drugs

Medigap policies sold today are standardized by the federal government and by California. Older Medigap policies that did include drug coverage haven't been sold since January 1, 2006, when Part D began. If you have one of those older policies, it may not be considered "creditable" drug coverage for Part D purposes — worth checking before you make changes.

For everyone else on Medigap, prescriptions come through Part D, period.

The timing rule that trips people up

Here is the part that costs people money: the Part D late enrollment penalty.

If you go 63 days or more in a row without "creditable" prescription drug coverage after your Initial Enrollment Period ends, Medicare can add a penalty to your Part D premium — for as long as you have Part D. The amount grows the longer you wait. Creditable coverage means drug coverage that's expected to pay, on average, at least as much as standard Part D.

Common ways people accidentally trigger the penalty:

• Signing up for Original Medicare and a Medigap policy, but skipping Part D because they don't take any daily prescriptions yet.
• Leaving an employer or union plan and not checking whether that plan's drug coverage was creditable.
• Missing the 63-day window after other creditable coverage ends.

If you don't take medications now, a Part D plan still protects you from that lifelong penalty — and from surprise costs later.

How Part D looks in 2026

A few program-level numbers to know for 2026:

• The maximum Part D deductible any plan can charge is $615.
• Once your out-of-pocket spending on covered drugs reaches $2,100, you pay $0 for covered drugs the rest of the year.
• The old "donut hole" coverage gap was eliminated in 2025, so Part D now has three payment phases instead of four.
• If you'd like to spread drug costs across the year in monthly amounts, the Medicare Prescription Payment Plan is available at no extra cost.
• Higher-income enrollees pay an IRMAA surcharge on top of the Part D premium; for single filers in 2026, IRMAA begins above $109,000 in income.

Every Part D plan has its own formulary (drug list), pharmacy network and premium, so the plan that fits a neighbor may not fit you. Compare using the Plan Finder at medicare.gov with your actual medications typed in.

When you can enroll or switch

• Initial Enrollment Period: the seven-month window around your 65th birthday (or your Medicare eligibility date). This is the cleanest time to add Part D and avoid the penalty.
• Annual Enrollment Period: October 15 through December 7 each year. You can join, drop or switch a stand-alone Part D plan for coverage starting January 1.
• Medicare Advantage Open Enrollment: January 1 through March 31. This window is for people already in a Medicare Advantage plan, not for Original Medicare + Medigap + Part D changes.
• Special Enrollment Periods: available for certain life events, like losing employer coverage or moving out of your plan's service area.

Where Santa Clarita residents can get unbiased help

• medicare.gov — the official Plan Finder, plan details and enrollment.
• 1-800-MEDICARE (1-800-633-4227), available 24/7.
• California's SHIP, called HICAP (Health Insurance Counseling & Advocacy Program), offers free, one-on-one counseling. Los Angeles County has local HICAP offices that serve Santa Clarita residents.