Medicare Supplement

Medigap Skips Drugs — Why Part D Timing Matters

In Sandy Springs, plenty of folks pair Original Medicare with a Medigap policy for the peace of mind it brings on hospital and doctor bills. Then a prescription lands at the pharmacy counter, and the surprise hits: Medigap does not pay for it. Medigap policies sold today are not designed to cover retail prescription drugs — that job belongs to a separate stand-alone Medicare Part D plan. Getting both pieces in place, on time, is what keeps your coverage complete and your future premium free of a lifelong late penalty.

How the three pieces fit together

Original Medicare is Part A (hospital) and Part B (doctor and outpatient). It pays a big share of your covered medical care, but it leaves deductibles and coinsurance behind — and, for most prescriptions you pick up at a pharmacy, it pays nothing.

A Medigap policy (also called Medicare Supplement Insurance) is bought from a private insurance company to help fill in those Part A and Part B cost-sharing gaps. According to the CMS Medigap rules on medicare.gov, Medigap plans sold today are not allowed to include drug coverage. Some people who bought a Medigap policy many years ago may still have older drug coverage attached, but new buyers won't.

A stand-alone Part D plan is the third piece. It's also sold by private insurers and is the part of Medicare designed to cover prescription drugs. If you want Original Medicare plus Medigap and drug coverage, you need to add a Part D plan on your own — it does not come automatically.

Why Sandy Springs residents should not skip Part D

Sandy Springs is in Fulton County, where Medicare beneficiaries have multiple stand-alone Part D plans to choose from during enrollment periods. Even if you take few or no prescriptions today, signing up for a Part D plan when you're first eligible protects you from two things: a future health surprise, and the Part D late enrollment penalty.

The penalty is not a one-time fee. If you go 63 days or more without "creditable" drug coverage after you become eligible, Medicare adds an amount to your Part D premium — and that amount stays with you for as long as you have Part D. It grows the longer you wait.

Creditable coverage means drug coverage that Medicare considers at least as good as a standard Part D plan. Employer or union coverage sometimes qualifies. If you have that, keep the notice your plan sends you each year — it's your proof.

The timing that keeps you out of the penalty

There are a few key windows to know:

• Initial Enrollment Period: The 7-month window around your 65th birthday (three months before, your birthday month, and three months after). Sign up for Part D here and you're safe.
• Special Enrollment Period: If you're losing creditable drug coverage from an employer, you generally have 63 days to pick up a Part D plan without penalty.
• Annual Enrollment Period: October 15 through December 7 each year. You can join, drop, or switch a Part D plan for coverage starting January 1.

If you enroll in Medigap when you first turn 65 but skip Part D because you're not taking any medications, the clock on the penalty starts ticking. It's a common — and expensive — mistake.

What Part D looks like in 2026

The CMS Part D program rules set several figures each year. For 2026:

• The maximum deductible a Part D plan can charge is $615.
• The annual out-of-pocket cap on covered drugs is $2,100. Once you hit it, you pay $0 for covered prescriptions for the rest of the calendar year.
• The old "donut hole" coverage gap is gone. Part D now has three phases: deductible, initial coverage, and catastrophic.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the calendar year in monthly bills instead of paying big amounts at the pharmacy counter. It's optional and free to opt into.
• Higher earners pay an IRMAA surcharge on top of the Part D premium. In 2026, that surcharge begins above $109,000 in income for a single filer (higher thresholds apply for joint filers).

Individual plan premiums, formularies, and pharmacy networks vary, so two neighbors in Sandy Springs can have very different Part D experiences depending on which plan and which medications are involved.

Steps to take before your next enrollment window

1. Confirm whether your current drug coverage — if any — is creditable. Look for the notice your plan mails each fall. 2. Make a list of every prescription you take, the dose, and the pharmacy you prefer. 3. Use the Plan Finder at medicare.gov to compare Part D plans available in Fulton County. You can enter your drug list and see how each plan handles them. 4. If you're new to Medicare, mark your Initial Enrollment Period on the calendar and don't let it pass without a Part D decision. 5. If you're already enrolled, review your Part D plan every fall between October 15 and December 7 — plans change year to year.