Medicare Supplement

Have Medigap in North Miami? Why you still need a separate Part D plan

NORTH MIAMI, Fla. — If you already have Original Medicare and a Medigap policy, you might assume your prescriptions are covered too. They aren't. Medigap — also called Medicare Supplement Insurance — helps pay some of the costs Original Medicare leaves behind, like coinsurance and copays. It does not pay for the pills you pick up at the pharmacy.

That's why most people in this situation add a stand-alone Medicare Part D plan. Getting the timing right matters, because a gap in drug coverage can trigger a penalty that sticks with you for life.

How the three pieces fit together

Think of it as a set of three:

• Original Medicare (Parts A and B) pays for hospital and medical care, but only covers a limited set of drugs (mostly those given in a hospital or doctor's office).
• Medigap helps pay your share of Original Medicare's costs — things like deductibles and coinsurance. It's sold by private insurers and follows standardized letter plans (A, B, D, G, K, L, M, N and, for those eligible before 2020, C and F).
• Part D is a separate, stand-alone prescription drug plan, also sold by private insurers under Medicare's rules.

Medigap plans sold today are not allowed to include drug coverage. Some very old Medigap policies (issued before 2006) did include drugs, but those have not been sold for nearly two decades.

Why Medigap and Part D go together

If you chose Original Medicare and a Medigap policy — instead of a Medicare Advantage plan — you have a lot of flexibility with doctors and hospitals nationwide. The trade-off is that you have to arrange drug coverage yourself.

That's not a flaw; it's how the program is designed. Medicare Advantage plans often bundle drug coverage in, while Original Medicare keeps the pieces separate so you can mix and match.

North Miami is in Miami-Dade County, where several private insurers offer stand-alone Part D plans. You can compare what's available using the Plan Finder tool at medicare.gov.

The Part D late enrollment penalty

Here's the trap to avoid. Medicare expects you to have "creditable" drug coverage — meaning coverage at least as good as a basic Part D plan — starting when you're first eligible for Medicare. If you go 63 days or more without it and later sign up for Part D, Medicare adds a penalty to your monthly premium.

The penalty is calculated as 1% of the "national base beneficiary premium" for each full month you went without creditable coverage, and it's added to your Part D premium for as long as you have Part D.

Creditable coverage can include:

• A stand-alone Part D plan
• A Medicare Advantage plan that includes drug coverage
• Certain employer or union retiree drug plans
• Some VA or TRICARE coverage

If you're keeping other drug coverage instead of enrolling in Part D right away, ask that plan for a creditable coverage notice in writing. Hang on to it.

Timing: when to enroll in Part D

The safest approach is to enroll in Part D during your Initial Enrollment Period — the seven-month window around your 65th birthday (three months before, your birthday month, and three months after). If you're delaying Medicare because you're still working, sign up for Part D within two months of losing that employer drug coverage using a Special Enrollment Period.

After that, the main chance to add or change a Part D plan is the Annual Enrollment Period, Oct. 15 – Dec. 7, with coverage starting Jan. 1.

One note for Medigap shoppers: your best price and guaranteed acceptance on a Medigap policy usually come during your 6-month Medigap Open Enrollment Period, which starts the month you're 65 or older and enrolled in Part B. Florida has some additional state protections, but outside that window, insurers can generally use medical underwriting. Your Part D timing and your Medigap timing are separate rules — don't confuse them.

What's new in Part D for 2026

A few program-level changes worth knowing:

• The maximum Part D deductible is $615 in 2026. Plans can charge less, but not more.
• There's now a $2,100 annual cap on what you pay out of pocket for covered drugs. Once you hit it, you pay $0 for the rest of the calendar year on covered prescriptions.
• The old "donut hole" coverage gap was eliminated in 2025. Part D now has three phases: deductible, initial coverage, and catastrophic.
• The Medicare Prescription Payment Plan lets you spread your drug costs across monthly payments instead of paying a large amount at the pharmacy counter. It's optional and free to opt into through your plan.
• Higher-income enrollees pay an IRMAA surcharge on Part D. For 2026, it starts above $109,000 in income for a single filer (based on your tax return from two years ago).

How to decide what to do next

A simple checklist for a North Miami reader who already has (or is considering) Medigap:

1. Confirm you have drug coverage from somewhere. If not, you likely need a stand-alone Part D plan. 2. Make a list of your prescriptions, including dosages, and note your preferred pharmacies. 3. Use the Plan Finder at medicare.gov to see which Part D plans in Miami-Dade County cover your drugs and at what pharmacies. 4. Check timing. Are you in your Initial Enrollment Period, a Special Enrollment Period, or the Oct. 15 – Dec. 7 Annual Enrollment Period? 5. Ask for free help. Florida's SHINE program (the state's SHIP) offers free, unbiased Medicare counseling.