Does Medigap Plan G Cover Prescriptions?

Does Medigap Plan G cover prescriptions? Prescription medications effectively treat illnesses and diseases, assist with rehabilitation, and prevent the development of certain conditions. Patients may avoid invasive treatments and more serious therapies by using prescription medications. Many prescription drugs that are available to patients come at a high price. The cost of drugs varies and depends on many factors. Still, it most commonly pertains to the medication’s availability, the amount of research money spent on it, and the availability of generic drug versions.

Medicare Benefits Solutions

Jul 18, 2021

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What Is Medigap?

Original Medicare covers many health care services and supplies, but there are other costs that it does not pay for, which causes a coverage “gap.” To help fill in these coverage gaps, some people rely on Medigap, which is Medicare Supplement insurance. 

A Medigap plan is not the same as a Medicare Advantage plan. It is only available to beneficiaries with Original Medicare Part A and Part B. You must still pay a premium for a Medicare Supplement plan, in addition to the Part B premium. A popular supplemental plan is Medigap Plan G. 

Does Medigap Plan G cover prescriptions? Plan G helps to reduce a recipient’s incurred medical costs for certain medical expenses because, for many people, Original Medicare coverage under Part A and Part B isn’t adequate enough to cover the majority of their medical expenses. Besides copays, coinsurance, and hospital deductibles, Medigap Plan G provides coverage for many expenses that Medicare may not cover. Unfortunately, it does not cover everything that Medicare doesn’t, like dental, vision, or long-term care. 

Coverage with the Medicare Supplement Insurance, Medigap Plan G

Plan G fully covers these health care costs:

  • Part A coinsurance and hospital costs at the end of your Medicare benefits for up to an additional 365 days.
  • Deductible for Medicare Part A.
  • Coinsurance or copayment for Part B.
  • Hospice care coinsurance or copayment for Part A.
  • Coinsurance for skilled nursing facility care.
  • Excess charge for Part B.
  • Eighty percent of medical care you receive outside the U.S., as determined by your plan’s limits.
  • Blood for medical procedures, up to three pints each year

Although Medicare Supplement Plan G coverage entails a deductible and other provisions that are designed to fill gaps in Medicare coverage, such as deductibles and copays for hospital stays and skilled nursing facilities that generally require additional payments on your part, it does not cover the cost of prescription medication. You will need to enroll in a Medicare Part D prescription plan for drug coverage. 

Medicare Part D Coverage

A standalone prescription drug plan covers generic and brand-name drugs. Medicare sets the standard coverage level for all plans. Each plan must cover the same category of drugs but the specific drugs covered in those various classifications, like diabetes or asthma medications, care determined by the plan provider. 

Each drug plan lists its covered drugs on a formulary. If the list does not have the medicine you need, there may be a similar option. Talk with your doctor to verify if alternative medications are acceptable. 

Drug costs can vary from plan to plan. Researching plans based on tiered pricing and copays is essential, especially if you have a budget. 

Tips for Choosing a Part D Plan

When looking for a prescription drug plan, consider the following tips when comparing your options:

  • A Medicare Part C (Medicare Advantage) plan that offers prescription drug coverage may also have restrictions on hospitals and doctors you can use.
  • Be sure a specific drug is on the plan’s formulary. You can compare prices with other plans from local insurance providers.
  • Suppose you don’t need prescription coverage now and feel you may need it in the future. Consider looking for a plan with a low monthly premium to give yourself peace of mind.
  • There may be a coverage gap for expensive medications. So, look for a plan that has a low deductible or extra coverage. 
  • If you have many generic prescriptions, choose a plan with tiers that may have low or no copayments.

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