Medicare Plan G is widely recognized for its comprehensive coverage, effectively filling most of the financial “gaps” left by Original Medicare (Parts A and B). However, when it comes to prescription drug coverage, there’s a crucial distinction that beneficiaries must understand: what is part g of medicare, Medicare Plan G, like all other Medicare Supplement (Medigap) plans sold today, does NOT include coverage for outpatient retail prescription drugs.
Why Medigap Plans Don’t Cover Retail Prescriptions
The reason for this lies in the history of Medicare. Prior to 2006, some Medigap plans did offer limited prescription drug benefits. However, with the introduction of Medicare Part D (Prescription Drug Plans) in 2006, the federal government standardized Medigap policies. Since then, Medigap plans are no longer allowed to offer significant outpatient prescription drug coverage.
This means that if you enroll in Medicare Plan G, your prescription medications obtained from a pharmacy will not be covered by that plan.
How to Get Prescription Drug Coverage with Plan G
If you choose Medicare Plan G (or any other Medigap plan) to supplement your Original Medicare, you have two primary options for obtaining prescription drug coverage:
- Enroll in a Stand-Alone Medicare Part D Prescription Drug Plan (PDP):
- This is the most common path for individuals with Plan G. You purchase a separate Part D plan from a private insurance company.
- Cost: You’ll pay an additional monthly premium for this Part D plan, which varies based on the specific plan, its formulary (list of covered drugs), and your location. You may also have a deductible, copayments, and coinsurance for your medications.
- Choice: You can choose a Part D plan that best fits your specific prescription needs, ensuring your current medications are on its formulary.
- Important: It’s highly recommended to enroll in a Part D plan when you first become eligible for Medicare, even if you don’t take many prescriptions. If you delay enrollment and don’t have other “creditable coverage” (like through an employer), you could face a late enrollment penalty added to your Part D premium for as long as you have Part D coverage.
- Choose a Medicare Advantage Plan (Part C) that Includes Drug Coverage:
- This is an alternative path, but it’s important to understand you cannot have a Medicare Advantage Plan and a Medigap plan (like Plan G) at the same time.
- Medicare Advantage plans are “all-in-one” plans offered by private companies that provide your Part A, Part B, and usually Part D benefits (known as MA-PD plans). They may also include additional benefits like dental, vision, and hearing coverage.
- If you choose a Medicare Advantage plan that includes prescription drug coverage, you do not need a separate Part D plan.
- Trade-off: While Medicare Advantage plans often have low or $0 monthly premiums, they usually have network restrictions (HMOs, PPOs), require referrals for specialists, and have out-of-pocket maximums that you might reach before your costs are fully covered. This is a very different approach to coverage than Original Medicare plus Plan G.
What Plan G Does Cover Related to Drugs
While Plan G doesn’t cover retail prescriptions, it’s important to distinguish this from medications that fall under Medicare Part B:
- Part B Medications: Plan G does cover the 20% coinsurance for medications that are covered under Medicare Part B. These are typically drugs administered in a doctor’s office or outpatient setting, such as:
- Injectable drugs given by a medical professional (e.g., some cancer chemotherapy, osteoporosis drugs).
- Infusion drugs.
- Vaccinations (like flu, pneumonia, hepatitis B).
- Durable medical equipment (DME) like nebulizers and the drugs used with them.
For these Part B-covered medications, once your annual Part B deductible ($257 in 2025) is met, Plan G will pay 100% of your coinsurance, just as it does for other Part B medical services.
The Bottom Line for Plan G and Prescription Drugs
If you’re considering Medicare Plan G, remember this crucial point: you will need to enroll in a separate Medicare Part D Prescription Drug Plan to cover your retail prescriptions. This dual coverage approach – Original Medicare + Medigap Plan G + Part D Plan – is a common and effective strategy for comprehensive health and drug coverage for many seniors.
