Medicare Supplement

Berwyn readers: why Medigap skips your pharmacy bill, and when to add Part D

If you live in Berwyn and you're piecing together Medicare for the first time, it helps to picture three separate pieces that snap together:

Three pieces, one Medicare puzzle

1. Original Medicare (Part A hospital and Part B medical), run by the federal government. 2. A Medigap policy (also called Medicare Supplement Insurance), sold by private insurers to help pay the deductibles, coinsurance and copays Original Medicare leaves behind. 3. A stand-alone Part D plan, also sold by private insurers, to help pay for prescription drugs you pick up at a pharmacy.

This is a different setup from a Medicare Advantage (Part C) plan, which bundles hospital, medical and usually drug coverage into one plan. With the Original Medicare + Medigap + Part D route, you're buying three products, and each one has its own rules.

What Medigap does — and does not — cover

A Medigap policy is designed to sit on top of Original Medicare. Depending on which lettered plan you buy (Plan G and Plan N are common examples), it can pick up things like the Part A hospital deductible, Part B coinsurance, and some other out-of-pocket costs.

What Medigap will not do is pay for the prescriptions you fill at your local pharmacy. Modern Medigap plans sold today are not allowed to include drug coverage. That's why the third piece — Part D — matters.

Some people assume that because Medigap "covers the gaps," it must cover drugs too. It doesn't. If you rely only on Original Medicare and a Medigap policy, you will pay full price at the pharmacy counter unless you have drug coverage from somewhere else.

Where Part D fits in

Part D is Medicare's prescription drug benefit. It's delivered through stand-alone drug plans (called PDPs) offered by private insurers that Medicare has approved. Each plan has its own list of covered drugs (the formulary), its own pharmacy network, and its own premium and cost-sharing.

For 2026, a few program-level facts are worth knowing:

• The maximum Part D deductible any plan can charge is $615.
• There is a new $2,100 annual out-of-pocket cap on what you pay for covered Part D drugs.
• The old "donut hole" coverage gap is gone as of 2025; Part D now has three phases instead of four.
• If drug costs are uneven month to month, you can ask your plan about the Medicare Prescription Payment Plan, which spreads your out-of-pocket drug costs across the calendar year.
• Higher-income beneficiaries pay an IRMAA surcharge on Part D; for 2026, that starts above $109,000 in income for a single filer.

Berwyn is in Cook County, where Part D plans are offered by several insurers. You can see the full list, along with each plan's formulary, on the Medicare Plan Finder at medicare.gov.

The timing that keeps you out of the Part D late penalty

Here's the part that trips people up.

The Part D late enrollment penalty is a lifelong surcharge added to your monthly Part D premium if you go 63 days or more in a row without either Part D or another form of creditable drug coverage (coverage Medicare considers at least as good as a standard Part D plan — for example, some employer or union plans).

The penalty is calculated as 1% of the national "base beneficiary premium" for every full month you went without coverage, and it typically sticks with you for as long as you have Part D. It's not a one-time fee.

To avoid it, most people should:

• 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), or the similar window when you first qualify for Medicare due to disability.
• Or keep creditable drug coverage without letting it lapse for 63 days or more. Every year, your employer, union or other drug plan should send you a "creditable coverage" notice — save it. If you lose that coverage, you have a Special Enrollment Period to pick up Part D, but the clock starts ticking right away.
• Or sign up during the Annual Enrollment Period, October 15 – December 7, if you missed your first window — but be aware a penalty may already apply.

The rule to remember: Medigap does not count as creditable drug coverage. Having a Medigap policy on its own will not protect you from the Part D penalty.

How the pieces work together at the pharmacy and the doctor

Once all three pieces are in place, here's roughly how a typical month looks:

• At the doctor or hospital: Original Medicare pays its share first. Your Medigap policy then pays some or all of the remaining deductibles, copays or coinsurance, depending on which lettered plan you chose.
• At the pharmacy: You show your Part D card. The Part D plan applies its deductible (if any), then its cost-sharing, until you hit the $2,100 out-of-pocket cap for 2026, after which covered drugs are $0 for the rest of the year.

Original Medicare and Medigap are one lane; Part D is a separate lane. They do not talk to each other, and one will not cover what the other misses.

A few Berwyn-area pointers

• Compare plans on medicare.gov. The Plan Finder lets you type in your Berwyn ZIP code and your specific medications so you can see how each Part D plan in Cook County would treat your drug list.
• Get free, unbiased help from SHIP. In Illinois, the State Health Insurance Assistance Program is called Illinois SHIP. Counselors do not sell plans and can walk you through Medigap and Part D choices side by side.
• Watch your Medigap enrollment window too. Your best chance to buy a Medigap policy with no medical underwriting is generally the six-month window that starts the month you're 65 or older and enrolled in Part B. That's a separate timing rule from Part D, but it's easy to overlook while you're focused on drug coverage.