Medicare Supplement

Medigap Won't Cover Your Pills — Here's How Part D Fits In

WOONSOCKET, R.I. — If you're piecing together Medicare coverage here in northern Rhode Island, there's one detail that trips up a lot of new enrollees: a Medigap policy will help pay your doctor and hospital bills, but it will not pay for the prescriptions you pick up at the pharmacy. For those, you need a separate Part D plan — and the clock on signing up starts sooner than most people think.

Here's how the three pieces work together, and how to avoid a lifetime penalty on your drug coverage.

The three pieces, in plain English

Think of this setup as a three-legged stool:

1. Original Medicare (Parts A and B) is your foundation. Part A covers inpatient hospital care; Part B covers doctor visits, outpatient care and many preventive services. It pays most of the bill, but not all of it — there are deductibles, and Part B generally leaves you responsible for 20% of the approved cost with no cap.

2. A Medigap (Medicare Supplement) policy is sold by private insurance companies and fills in some of those out-of-pocket amounts Original Medicare leaves you owing. Different lettered plans (like Plan G or Plan N) cover different combinations of costs.

3. A stand-alone Part D plan is your prescription drug coverage. It's also sold by private insurers, but it's a separate product with its own premium, formulary and pharmacy network.

Together, these three pieces are one way to build coverage. The other main path is a Medicare Advantage (Part C) plan, which bundles hospital, medical and usually drug coverage into a single plan. You generally can't combine Medigap with Medicare Advantage.

Why Medigap and Part D are sold separately

This surprises people, but it's built into federal law. Medigap policies sold since 2006 are not allowed to include prescription drug coverage, according to CMS Medicare Supplement rules on medicare.gov. If you want drug coverage while you have Original Medicare and Medigap, you have to buy a stand-alone Part D plan.

Woonsocket is in Providence County, where multiple stand-alone Part D plans are offered each year. The exact number and lineup can change annually, so it's worth checking the Plan Finder on medicare.gov during open enrollment.

The timing that keeps you out of the late penalty

This is the part that costs people real money if they miss it.

Medicare charges a Part D late enrollment penalty if you go 63 or more days in a row without "creditable" drug coverage after your Initial Enrollment Period ends. Creditable coverage means drug coverage that's expected to pay, on average, at least as much as a standard Part D plan — often from an employer or union.

The penalty is added to your Part D premium for as long as you have Part D. It's not a one-time fee; it follows you.

To stay clear of it:

• Enroll during your Initial Enrollment Period. That's the seven-month window around your 65th birthday — three months before, your birthday month, and three months after.
• If you're delaying because you have other drug coverage, keep the annual notice from that plan telling you it's "creditable." You'll need it later.
• When that other coverage ends, you generally have a two-month Special Enrollment Period to pick up Part D without a penalty.

Key dates to remember

• Annual Enrollment Period: October 15 – December 7. This is when anyone with Medicare can join, switch or drop a Part D plan for the following year.
• Medicare Advantage Open Enrollment Period: January 1 – March 31, for people already in a Medicare Advantage plan who want to switch or return to Original Medicare (and add Part D).
• Your Medigap open enrollment window is a separate, one-time six-month period that starts when you're 65 or older and enrolled in Part B. During that window, insurers generally can't turn you down or charge you more based on health history.

What's new for 2026

A few program-level changes worth knowing as you plan:

• The Part D out-of-pocket cap is $2,100 for 2026. Once your drug spending hits that amount, you pay nothing more for covered drugs the rest of the year.
• The maximum Part D deductible is $615.
• 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 calendar year in monthly payments instead of paying large amounts at the pharmacy counter. It's optional and free to sign up.
• IRMAA surcharges — higher Part B and Part D premiums tied to income — begin above $109,000 for a single filer in 2026.