Medicare 2026

Medicare Advantage or Medigap? How Sitka Seniors Can Decide

In Sitka, turning 65 often brings the same question: should you stick with Original Medicare and add a Medigap policy, or go with a Medicare Advantage plan? The two paths are built very differently, and understanding that difference is the first step to choosing well.

Key takeaways

• Original Medicare plus Medigap and Medicare Advantage are two separate structures, not two versions of the same coverage.
• Original Medicare is federal coverage you can use with any provider who accepts Medicare; Medicare Advantage plans are run by private insurers and typically use networks.
• Part D has a $2,100 out-of-pocket cap and a $615 maximum deductible in 2026; in 2027 the cap is $2,400 and the maximum deductible is $700. These figures apply regardless of which path you choose.
• The Annual Enrollment Period runs October 15 to December 7, and Medicare Advantage Open Enrollment runs January 1 to March 31.

Two different structures, not two flavors of the same thing

Original Medicare is the federal program itself. It has two parts: Part A (hospital) and Part B (doctor and outpatient). You can see any doctor or hospital in the country that accepts Medicare, and there is no network. Original Medicare does not cap what you pay out of pocket each year, which is why many people add a Medigap (Medicare Supplement) policy to help cover coinsurance and deductibles. Most also add a stand-alone Part D plan for prescription drugs.

Medicare Advantage (Part C) is different. It is private insurance that replaces the way you receive your Part A and Part B benefits. The plan sets its own network, rules, and cost-sharing, and most Advantage plans include Part D drug coverage built in. Advantage plans do have an annual out-of-pocket maximum for medical care, which Original Medicare alone does not.

What Sitka residents should know about local availability

Sitka is in Sitka City and Borough, which Medicare treats as its own county for plan availability. Because Alaska’s Medicare Advantage market is limited compared with the Lower 48, many Sitka residents end up choosing Original Medicare with a Medigap policy and a separate Part D drug plan. To see exactly what is offered in the borough for the coming year, use the Plan Finder at medicare.gov and enter your ZIP code — that is the only source that reflects current, county-level availability.

How the two paths handle doctors and referrals

With Original Medicare, you do not need referrals, and you can travel anywhere in the U.S. and use any Medicare-accepting provider. That flexibility matters in Southeast Alaska, where specialty care often means a trip to Anchorage, Seattle, or beyond.

Medicare Advantage plans typically use HMO or PPO networks. Some require referrals to see specialists, and out-of-network care may cost more or not be covered except in emergencies. If you travel frequently or split time outside Alaska, ask carefully about how the plan handles care away from home.

How prescription drugs fit in

Part D drug coverage follows the same federal rules no matter which path you take. In 2027:

• The maximum Part D deductible is $700.
• Once you hit $2,400 in out-of-pocket drug costs, you pay nothing more for covered drugs the rest of the year.
• The old coverage gap (“donut hole”) is gone — there are now three phases.
• The Medicare Prescription Payment Plan lets you spread drug costs across the year in monthly installments if you choose.

With Original Medicare, you add a stand-alone Part D plan. With most Medicare Advantage plans, drug coverage is built in.

Medigap: the piece that changes the math

Medigap only works with Original Medicare — you cannot use it with Medicare Advantage. Medigap policies help pay the deductibles and coinsurance Original Medicare leaves behind, which is how people create predictable monthly costs.

The catch: your best window to buy Medigap is the six-month Medigap Open Enrollment Period that starts when you are 65 and enrolled in Part B. During that window, insurers cannot turn you down or charge more for health reasons. After that, in most states, they can. Alaska residents should confirm current rules with the Alaska Division of Insurance or the state SHIP office.

Income, IRMAA, and enrollment dates

If your income is above $109,000 as a single filer in 2026, you may pay an IRMAA surcharge on top of your Part B and Part D premiums. That applies on either path.

Two dates to remember:

• Annual Enrollment Period: October 15 – December 7. You can join, switch, or drop a Medicare Advantage or Part D plan.
• Medicare Advantage Open Enrollment: January 1 – March 31. If you are already in an Advantage plan, you can switch to another Advantage plan or return to Original Medicare.

How to decide

There is no single right answer. Ask yourself:

• Do I want the freedom to see any Medicare provider, including out of state?
• Am I willing to pay a Medigap premium for more predictable costs?
• Do I want extra benefits some Advantage plans offer, understanding the trade-off of networks and rules?
• What does my current doctor accept, and what happens if I need care outside Sitka?

Talking with a counselor at Alaska’s State Health Insurance Assistance Program (SHIP) is a good next step — SHIP counselors are trained, unbiased, and free.