Medicare Supplement

Aspen Hill readers ask: why doesn't my Medigap plan pay for prescriptions?

ASPEN HILL, Md. — If you live in Aspen Hill and you already have Original Medicare with a Medigap policy, you may have noticed something at the pharmacy counter: your supplement does not pay for your prescriptions. That is not a mistake on your card. Modern Medigap plans are not built to cover retail drugs, and that means a separate stand-alone Part D plan has to do that job. Getting the timing right is what keeps you out of a late-enrollment penalty that can follow you for life.

Medicare SupplementAspen Hill, MD

How the three pieces fit together

Original Medicare is the federal program: Part A (hospital) and Part B (doctor and outpatient). It pays most of your medical bills, but it leaves deductibles and coinsurance for you.

A Medigap policy — also called a Medicare Supplement — is private insurance that fills in some of those out-of-pocket costs from Original Medicare. Medigap does not replace Medicare; it works alongside it.

A stand-alone Part D plan is separate private insurance that covers prescription drugs you pick up at a pharmacy. If you want Original Medicare plus Medigap and drug coverage, you need to enroll in Part D on its own.

That is the trio: Original Medicare + Medigap + Part D. Each piece has its own card, its own rules, and its own enrollment.

Why Medigap doesn't cover prescriptions

It wasn't always this way. Older Medigap plans once included some drug coverage, but that changed after Part D was created in 2006. Since Jan. 1, 2006, new Medigap policies sold in the U.S. cannot include prescription drug benefits. That is why the supplement on your desk today only pays toward medical costs like the Part B coinsurance or a hospital deductible — not toward the pills your doctor prescribes.

If you were grandfathered into an older Medigap plan that still has drug coverage, that is a narrow exception, and Medicare treats those older plans by their own rules. Most Aspen Hill residents shopping today are looking at Medigap plans that pair with a separate Part D plan.

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

Here is where people get tripped up. Medicare charges a Part D late-enrollment penalty if you go 63 days or more in a row, after your Initial Enrollment Period, without either a Part D plan or other "creditable" drug coverage (coverage Medicare considers at least as good as Part D).

That penalty is added to your monthly Part D premium — and once it starts, you generally pay it for as long as you have Part D. It is not a one-time fee.

To stay clear of it:

• Enroll in a Part D plan during your Initial Enrollment Period around your 65th birthday, even if you don't take many drugs today.
• Or keep proof of creditable coverage (for example, from an employer or union plan) and enroll in Part D within 63 days of losing it.
• If you miss both windows, you can usually only join Part D during the Annual Enrollment Period, Oct. 15 – Dec. 7, with coverage starting Jan. 1.

What Part D looks like in 2026

A few program-level numbers to keep in mind as you compare plans:

• The Part D deductible can be up to $615 in 2026.
• Once you hit $2,100 in out-of-pocket drug costs, you are done paying for covered drugs the rest of the year — that is the new annual cap.
• The old "donut hole" coverage gap is gone as of 2025. Part D now has three phases instead of four.
• If a big prescription bill would be hard to pay all at once, the Medicare Prescription Payment Plan lets you spread your drug costs across the calendar year in monthly installments at no extra charge.
• Higher-income beneficiaries may pay an IRMAA surcharge on Part D. For a single filer in 2026, that begins above $109,000 in income (based on your tax return from two years earlier).

Comparing Part D plans in Aspen Hill

Aspen Hill is in Montgomery County, where stand-alone Part D plans are sold by several private insurers under contract with Medicare. Plan lists, formularies (the drugs each plan covers), and pharmacy networks are set at the county level, so two neighbors in Aspen Hill see the same menu of plans.

When you compare, look at:

• Whether your specific drugs are on the plan's formulary.
• Which pharmacies are in-network near you.
• The plan's deductible and cost-sharing tiers.
• Whether mail-order is an option you'd use.

The Plan Finder at medicare.gov lets you enter your drugs and ZIP code and see how each plan handles them. You can also get free, unbiased help from Maryland's State Health Insurance Assistance Program (SHIP), called SHIP/SMP in Maryland.