Medicare Supplement

Medigap Skips the Pharmacy? Add Part D or Face a Lifelong Penalty

POCATELLO, Idaho — If you're pairing Original Medicare with a Medigap policy here in the Gate City, there's one gap the supplement almost never fills: your prescriptions at the pharmacy counter. Medigap plans sold today cover things like Part A and Part B cost-sharing, but they do not include drug coverage. To get that, you need a stand-alone Part D plan — and the clock on signing up starts sooner than many people realize.

How the three pieces fit together

Think of Original Medicare, Medigap, and Part D as three separate tools that work as a set.

• Original Medicare (Parts A and B) pays for hospital stays and doctor visits, but leaves you with deductibles and coinsurance.
• A Medigap (Medicare Supplement) policy helps pay those leftover costs — the coinsurance, copays, and deductibles Original Medicare doesn't.
• A stand-alone Part D plan is what covers your prescription drugs at the pharmacy.

Medigap plans sold to people newly eligible today are not allowed to include drug coverage. So if drugs matter to you — and for most people, they do — Part D is the missing piece.

Why the timing trips people up

Here's where readers get burned: the Part D late enrollment penalty.

If you go 63 days or more in a row without "creditable" drug coverage after your Initial Enrollment Period ends, Medicare can charge you a penalty. That penalty gets added to your Part D premium every month — for as long as you have Part D. It doesn't go away.

The safe move: sign up for a Part D plan when you first become eligible for Medicare, usually the seven-month window around your 65th birthday. If you're keeping employer or union drug coverage past 65, ask your benefits office in writing whether that coverage is "creditable." If it is, you can delay Part D without a penalty. If it isn't, don't wait.

What Part D looks like in 2026

A few program-level numbers to keep in mind for 2026:

• The maximum Part D deductible is $615. Plans can charge less, but not more.
• There is a new $2,100 annual cap on what you pay out of pocket for covered drugs. Once you hit it, you pay $0 for covered prescriptions the rest of the year.
• The old "donut hole" coverage gap was eliminated in 2025, so Part D now has three phases instead of four.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the year in monthly payments instead of paying big amounts at the pharmacy.
• IRMAA surcharges — extra premium amounts based on income — kick in above $109,000 for a single filer in 2026.

What's available in Pocatello

Pocatello is in Bannock County, where a number of stand-alone Part D plans are offered each year, along with Medicare Advantage plans that include drug coverage. Plan availability, formularies (the list of covered drugs), and pharmacy networks change every year, which is why comparing during Open Enrollment matters.

You can see the specific plans available in Bannock County by using the Plan Finder at medicare.gov and entering your ZIP code and your medication list.

Key dates to remember

• Initial Enrollment Period: the seven-month window around your 65th birthday.
• Annual Enrollment Period (AEP): Oct. 15 – Dec. 7. This is when anyone with Medicare can join, switch, or drop a Part D plan for the following year.
• Medicare Advantage Open Enrollment: Jan. 1 – March 31, for people already in a Medicare Advantage plan who want to switch.

Even if you're happy with your current Part D plan, it's worth a quick check each fall. Premiums, covered drugs, and preferred pharmacies can shift from one plan year to the next.

Where to get unbiased help

You don't have to figure this out alone, and you don't have to rely on a sales pitch to do it.

• medicare.gov — the official Plan Finder lets you enter your drugs and compare Part D plans in Bannock County side by side.
• 1-800-MEDICARE (1-800-633-4227) — available 24/7 for questions about enrollment and penalties.
• Idaho SHIBA — Idaho's State Health Insurance Assistance Program (SHIP) offers free, one-on-one Medicare counseling. Trained counselors can walk you through Medigap and Part D options without trying to sell you anything.