Medicare 2026

Medigap and Medicare Advantage: the structural split in Sitka

In Sitka, turning 65 usually brings the same question: should you stick with Original Medicare and add a Medigap policy, or take the Medicare Advantage route? Both are legitimate paths, and both are built into the Medicare program — but they are structured very differently, and that structure shapes what you pay, which doctors you can see, and how you handle a bill when it comes.

Key takeaways

• Original Medicare (Parts A and B) is the federal program itself; Medigap and Part D are add-ons you buy separately to fill its gaps.
• Medicare Advantage (Part C) is a private plan that replaces how you receive your Medicare benefits, usually bundling drug coverage and using a network.
• In 2026, Part D has a $2,100 out-of-pocket cap and a maximum $615 deductible; in 2027 the cap is $2,400 and the maximum deductible is $700. The old “donut hole” is gone.
• The Annual Enrollment Period runs Oct. 15 – Dec. 7, and Medicare Advantage Open Enrollment runs Jan. 1 – March 31.

The two structures, in plain terms

Original Medicare is the federal program. Part A covers hospital stays, and Part B covers doctor visits and outpatient care. You can go to almost any provider in the country that accepts Medicare. But Original Medicare has no yearly cap on what you might owe out of pocket, and it does not include prescription drugs.

That is why many people who choose this path add two things: a Medigap policy (also called Medicare Supplement Insurance) to help pay the deductibles and coinsurance Original Medicare leaves behind, and a stand-alone Part D plan for prescriptions.

Medicare Advantage, sometimes called Part C, works differently. You still have Medicare, but a private insurance company delivers your benefits through its own plan. Most Advantage plans include Part D drug coverage and may offer extras beyond what Original Medicare covers. In exchange, they typically use provider networks (HMOs or PPOs), require referrals or prior authorization for some services, and set their own copays and yearly out-of-pocket maximum.

You cannot use both at the same time. If you enroll in Medicare Advantage, a Medigap policy cannot pay your Advantage plan’s cost-sharing.

What this looks like in Sitka

Sitka sits in the Sitka Borough, which Medicare treats as its own county-level area for plan availability. Because Alaska’s Medicare Advantage market is limited compared with the Lower 48, many Sitka residents end up on the Original Medicare + Medigap + Part D path simply because that is what travels well across the state and works with the providers available locally, including care that may require a trip to Anchorage or Seattle.

The exact number and type of Advantage plans offered in the Sitka Borough can shift from year to year. You can check what is available for your ZIP code using the Plan Finder at medicare.gov.

How costs are shaped on each path

On the Original Medicare + Medigap side, you generally pay:

• Your Part B premium (paid to Medicare)
• A Medigap premium (paid to the private insurer)
• A Part D premium (paid to the drug plan)

In return, once your Medigap policy kicks in, your share of most Medicare-covered services is predictable.

On the Medicare Advantage side, you still pay your Part B premium, plus whatever the Advantage plan charges. Cost-sharing happens as you use services — copays for visits, hospital stays, imaging — up to the plan’s annual out-of-pocket limit for in-network care.

Neither path is automatically cheaper. It depends on your health, your prescriptions, and how often you travel.

The Part D drug coverage rules apply either way

Whether your Part D coverage comes through a stand-alone plan or is built into a Medicare Advantage plan, the same program-level rules apply:

• Out-of-pocket drug costs are capped at $2,100 for the year.
• The Part D deductible cannot exceed $615.
• The old coverage gap (“donut hole”) is gone — Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the year in monthly installments instead of paying big amounts at the pharmacy counter.

Higher-income beneficiaries may also pay an IRMAA surcharge on Part B and Part D. In 2026, IRMAA begins above $109,000 in income for a single filer.

When you can make a change

Two windows matter most:

• Annual Enrollment Period: Oct. 15 – Dec. 7. You can join, switch, or drop a Medicare Advantage or Part D plan for the coming year.
• Medicare Advantage Open Enrollment: Jan. 1 – March 31. If you are already in an Advantage plan, you can switch to a different one or return to Original Medicare (and pick up a Part D plan).

One important caveat for the Medigap side: outside of your initial six-month Medigap Open Enrollment Period at age 65, insurers in most states can use medical underwriting when you apply. That means if you start on Medicare Advantage and later want to move to Original Medicare with a Medigap policy, you may be asked health questions, and coverage is not guaranteed. This is one of the biggest structural trade-offs to understand up front.

Where to get unbiased help in Sitka

You don’t have to sort this out alone, and you shouldn’t rely on a sales pitch to do it.

• Medicare.gov — official plan comparisons and rules
• 1-800-MEDICARE (1-800-633-4227) — 24/7
• Alaska Medicare Information Office / SHIP — free, one-on-one counseling from trained volunteers who do not sell insurance. Ask about services available to Sitka residents.