Medicare Supplement Insurance, also known as Medigap, is designed to help cover out-of-pocket costs that Original Medicare (Part A and Part B) does not pay. However, when it comes to pharmacy benefits and prescription drug coverage, Medicare Supplement plans have specific limitations that beneficiaries need to understand.
Do Medicare Supplement Plans Cover Pharmacy?
No, Medicare Supplement plans do not cover prescription drugs. Medigap policies are designed to help with costs like copayments, coinsurance, and deductibles related to hospital stays and medical services under Original Medicare. They do not include outpatient prescription drug coverage, which is an essential part of managing healthcare costs for many seniors.
To get prescription drug coverage, individuals enrolled in a Medigap plan must purchase a separate Medicare Part D (Prescription Drug Plan).
What Is the Downside to Medicare Supplement Plans?
While Medicare Supplement plans offer extensive coverage for out-of-pocket medical expenses, they come with some disadvantages:
- No Prescription Drug Coverage – Unlike Medicare Advantage (Part C) plans, Medigap policies do not cover prescription drugs, so beneficiaries need a separate Part D plan.
- Higher Monthly Premiums – Medigap plans tend to have higher premiums than some Medicare Advantage plans.
- No Additional Benefits – Medigap does not provide vision, dental, hearing, or wellness programs, unlike some Medicare Advantage options.
- Limited Provider Networks – While Medigap allows access to any provider that accepts Medicare, certain plans may have state-specific limitations.
Does the G Plan Include Prescription Drugs?
No, Medicare Supplement Plan G does not include prescription drug coverage. Plan G is one of the most comprehensive Medigap plans, covering nearly all out-of-pocket costs except for the Medicare Part B deductible. However, those enrolled in Plan G must enroll in a separate Part D plan if they need prescription drug benefits.
What Is Not True of Medicare Supplement Insurance Plans?
There are several misconceptions about Medicare Supplement (Medigap) plans. Below are some common myths debunked:
❌ Medigap plans cover prescription drugs – False. You need a Medicare Part D plan for drug coverage.
❌ Medigap and Medicare Advantage are the same – False. Medigap supplements Original Medicare, while Medicare Advantage (Part C) replaces it and includes extra benefits.
❌ Medigap plans cover vision, dental, and hearing – False. Medigap covers only medical expenses under Original Medicare.
❌ You can switch Medigap plans anytime – False. While you can switch plans, in many cases, you might have to go through medical underwriting and could be denied coverage or face higher premiums.
How to Get Prescription Drug Coverage with Medicare Supplement
If you’re enrolled in a Medicare Supplement plan and need pharmacy benefits, follow these steps:
- Enroll in a Medicare Part D Plan – Medicare Part D covers outpatient prescription drugs, and plans vary based on premiums, formularies, and copayments.
- Compare Part D Plans Annually – Prescription drug plans change each year, so reviewing options during the Medicare Annual Enrollment Period (AEP) (October 15 – December 7) ensures you get the best coverage.
- Check Medication Coverage – Each Part D plan has a formulary (drug list) that determines which medications are covered and at what cost.
Conclusion
Medicare Supplement (Medigap) plans do not cover pharmacy benefits or prescription drugs. To receive coverage for medications, beneficiaries must enroll in a Medicare Part D plan separately. While Medigap provides excellent coverage for medical costs, it’s essential to understand its limitations and plan accordingly for prescription drug needs.
If you’re considering Medicare Supplement coverage and need help selecting the right Part D plan, contact MedCare Advisor today for expert guidance!
