Medicare Supplement

Medigap Skips the Pharmacy: Add Part D or Face a Lifelong Fee

# Medigap Skips the Pharmacy: Add Part D or Face a Lifelong Fee

YAKIMA, Wash. — If you're moving to Original Medicare and buying a Medigap policy to smooth out your hospital and doctor bills, there's one gap that surprises a lot of people: your prescription drugs. Medigap does not cover them. To get drug coverage alongside Original Medicare and a supplement, you need a separate stand-alone Part D plan — and the timing of when you sign up matters for the rest of your life.

Here's how the three pieces fit together, and how to avoid the Part D late enrollment penalty.

The three pieces of "Original Medicare plus a supplement"

When you choose Original Medicare instead of a Medicare Advantage plan, you're usually building coverage out of three separate pieces:

1. Original Medicare (Parts A and B) — federal coverage for hospital and medical services. 2. A Medigap (Medicare Supplement) policy — private insurance that helps pay your share of Part A and Part B costs, like coinsurance and deductibles. 3. A stand-alone Part D plan — private insurance for prescription drugs you pick up at the pharmacy.

Each piece is billed separately, and each has its own rules. Medigap and Part D are both sold by private insurance companies, but they are different products with different enrollment windows.

Why Medigap doesn't include drug coverage

Older Medigap policies used to include some drug coverage, but that changed when Part D was created in 2006. Since then, any new Medigap policy sold has been drug-free by design. If you have Original Medicare and want prescription coverage, the standard path is a separate Part D plan.

That's true whether you live in downtown Yakima, out toward Selah, or up in the Naches Valley — the rule is national, not local.

The Part D late enrollment penalty — and how to dodge it

This is where timing bites people.

If you go 63 days or more in a row without creditable drug coverage after your Initial Enrollment Period for Medicare, you can be charged a late enrollment penalty when you finally sign up for Part D. The penalty gets added to your monthly premium — and it sticks around for as long as you have Part D. It's not a one-time fee.

"Creditable" simply means the drug coverage is expected to pay, on average, at least as much as standard Part D. Employer plans, union plans, TRICARE, and VA benefits often qualify, but you should get that in writing from the plan. Your insurer is required to send you a notice each year telling you whether your coverage is creditable.

Two simple ways to stay safe:

• Enroll in a Part D plan during your Initial Enrollment Period — the seven-month window around your 65th birthday.
• If you're keeping other creditable drug coverage (say, from a current job), sign up for Part D within 63 days of losing it.

What Part D looks like in 2026

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

• The maximum Part D deductible is $615.
• The annual out-of-pocket cap for covered drugs is $2,100. Once you hit it, you pay $0 for covered drugs the rest of the year.
• The old coverage gap ("donut hole") is gone — 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 big amounts at the pharmacy counter.
• IRMAA — an income-related surcharge — starts above $109,000 for a single filer in 2026 and can add to your Part D premium.

Every Part D plan has its own formulary (list of covered drugs), pharmacy network, and pricing tiers, so two plans can look very different for the same person depending on the medications you take.

When you can enroll or switch

• Initial Enrollment Period: the seven months around your 65th birthday.
• Annual Enrollment Period: October 15 – December 7 each year, for coverage that starts January 1.
• Medicare Advantage Open Enrollment: January 1 – March 31 (this one is for people already in Advantage plans, not for stand-alone Part D switches from Original Medicare).
• Special Enrollment Periods may apply if you move, lose other coverage, or have certain life changes.

Yakima is in Yakima County, where multiple stand-alone Part D plans are available from several insurance companies. You can see the full list — and how each one covers your specific medications — using the Plan Finder at medicare.gov.

A quick word on Medigap timing

Part D isn't the only piece with a timing trap. Your best window to buy a Medigap policy is generally your six-month Medigap Open Enrollment Period, which starts the month you're 65 or older and enrolled in Part B. During that window, insurers can't turn you down or charge you more for health reasons. After it closes, medical underwriting can come into play in most states.

That's a separate rule from Part D, but the two windows often overlap, so it's worth thinking about both at the same time.