Medicare Supplement

Medigap Won't Cover Your Drugs — Why Part D Timing Matters

In Pasadena, retirees who pick Original Medicare and a Medigap policy sometimes assume their prescriptions are handled too. They aren't. Medigap — also called Medicare Supplement Insurance — helps pay the out-of-pocket costs Original Medicare leaves behind, like deductibles and coinsurance. It does not pay for the drugs you pick up at the pharmacy counter. For that, you need a separate stand-alone Part D plan, and signing up on time is what keeps a lifelong late-enrollment penalty off your monthly bill.

How the three pieces fit together

Think of Original Medicare, Medigap, and Part D as three parts of one setup:

• Original Medicare (Parts A and B) covers hospital stays and doctor visits, but leaves you responsible for deductibles and coinsurance.
• Medigap is private insurance that helps pay those leftover costs. It works alongside Original Medicare.
• Part D is a separate private plan that covers prescription drugs.

Medigap plans sold today are not allowed to include drug coverage. A very small number of people still have older "grandfathered" Medigap policies from before 2006 that included drugs, but no one new can buy one.

Pasadena is in Harris County, where residents on Original Medicare can shop for a stand-alone Part D plan from several private insurers approved by Medicare. You choose the drug plan; it doesn't come attached to your Medigap policy.

Why the timing matters

Part D has a late enrollment penalty, and it's not a one-time fee — it's added to your monthly premium for as long as you have Medicare drug coverage.

You can avoid it by doing one of three things:

1. Sign up for a Part D plan during your Initial Enrollment Period — the seven-month window around your 65th birthday. 2. Keep creditable drug coverage through another source (like an employer, union, or VA plan) and enroll in Part D within 63 days after that coverage ends. 3. Qualify for Extra Help, the federal program that assists people with limited income.

If you go more than 63 days in a row without creditable drug coverage after your Initial Enrollment Period, the penalty clock starts. It's calculated based on how many months you went without coverage, and it follows you.

What Part D looks like in 2026

A few program-wide numbers to know for 2026:

• The maximum Part D deductible is $615. Plans can set a lower deductible, but not a higher one.
• The annual out-of-pocket cap on covered drugs is $2,100. Once you reach it, you pay nothing more for covered prescriptions that year.
• The old "donut hole" coverage gap was eliminated in 2025, so Part D now has three simpler phases.
• The Medicare Prescription Payment Plan lets you spread your drug costs into predictable monthly payments instead of paying big bills at the pharmacy.
• IRMAA surcharges — extra amounts tied to income — start above $109,000 for single filers in 2026.

When you can enroll or switch

The Annual Enrollment Period runs from October 15 through December 7 every year. This is when someone on Original Medicare and Medigap can pick up a Part D plan, drop one, or switch to a different one for the following January 1.

The Medicare Advantage Open Enrollment Period (January 1 – March 31) is mainly for people already on a Medicare Advantage plan, not for stand-alone Part D shoppers on Original Medicare.

Special Enrollment Periods can also open up if you move, lose other coverage, or have certain life changes.

A practical checklist for Pasadena readers

• Write down every prescription you take, including the dose and how often.
• Check with your pharmacy about which Part D plans it works with.
• Use the Plan Finder at medicare.gov to compare drug plans available in Harris County.
• If you had drug coverage through an employer or union, keep the letter that says whether it was "creditable" — you may need to prove it later.