Medicare 2026

Before you pick a Medicare path in Peoria: how the two structures actually differ

PEORIA, Ariz. — When people in Peoria first sign up for Medicare, they run into a fork in the road that can feel confusing. Do you stay with Original Medicare and add a Medigap policy? Or do you go with a Medicare Advantage plan? These are not two flavors of the same thing. They are two different structures for how your coverage is built, who pays your bills, and how you use doctors and hospitals.

This guide walks through the plumbing of each path so the choice makes sense before the next Annual Enrollment Period (Oct. 15 – Dec. 7) rolls around.

Path one: Original Medicare, and where Medigap fits in

Original Medicare is the federal program itself — Part A (hospital) and Part B (doctor and outpatient). You can see any provider in the country that accepts Medicare, and the government pays its share of each claim directly. There is no network and no referral system.

The trade-off is that Original Medicare does not have an out-of-pocket maximum. Part A has a deductible per benefit period, and Part B pays 80% of most approved charges, leaving you responsible for the other 20% with no ceiling.

That is where Medigap (also called Medicare Supplement Insurance) comes in. Medigap is a separate private policy you buy to help pay the deductibles, copays and coinsurance that Original Medicare leaves behind. Medigap plans are standardized by letter (Plan G, Plan N and so on), so a Plan G from one insurer covers the same gaps as a Plan G from another. What can differ is the premium and the customer service — not the benefits.

Because Original Medicare does not include drug coverage, most people on this path also add a stand‑alone Part D prescription plan.

Path two: Medicare Advantage (Part C)

Medicare Advantage is different at the foundation. You are still enrolled in Medicare, but you assign your Part A and Part B benefits to a private insurer that runs your plan under contract with the federal government. The insurer — not Medicare directly — processes your claims and sets the rules.

Advantage plans usually work through networks (HMO or PPO), often require referrals or prior authorization for certain services, and by law must include an annual out-of-pocket maximum for Part A and Part B care. Most bundle in Part D drug coverage and may include extras Original Medicare does not offer, like routine dental, vision or hearing benefits. What is offered, and under what rules, varies plan by plan.

Peoria is in Maricopa County, where Medicare Advantage availability is set at the county level. You can view the full current list on the Medicare Plan Finder at medicare.gov/plan-compare.

The key structural differences

A few plain-English contrasts:

• Who pays your claim: Medicare itself (Original) vs. a private insurer (Advantage).
• Provider access: Any Medicare provider nationwide (Original) vs. a plan network, often regional (Advantage).
• Out-of-pocket cap: None on Original Medicare alone; Medigap fills the gaps. Advantage plans have a yearly cap by law.
• Drug coverage: Add a stand-alone Part D plan (Original) vs. usually built in (Advantage).
• Extra benefits: Not part of Original Medicare; sometimes included in Advantage.
• Underwriting: Medigap can be medically underwritten outside your initial 6‑month open enrollment window in most states, meaning insurers can review your health history. Advantage plans generally cannot use health status to deny enrollment during valid election periods.

You cannot use both structures at once. Medigap is designed to work with Original Medicare and is not meant to pair with a Medicare Advantage plan.

What stays the same in 2027 no matter which path you pick

Some Medicare rules apply across the board:

• The Part D out-of-pocket cap is $2,100 in 2026, and the maximum Part D deductible is $615.
• The old coverage gap ("donut hole") has been eliminated since 2025; Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread your yearly drug costs into monthly payments if you choose.
• IRMAA surcharges on Part B and Part D premiums begin above $109,000 in income for a single filer in 2026.
• Annual Enrollment Period: Oct. 15 – Dec. 7. Medicare Advantage Open Enrollment: Jan. 1 – March 31 (for people already in an Advantage plan).

These figures come from CMS and apply whether you are on Original Medicare with Medigap or in a Medicare Advantage plan.

How to think it through

There is no universally "right" path — the honest answer is that it depends on your health, your budget, which doctors you want to keep, and how much predictability you want in your monthly costs versus your yearly out-of-pocket exposure.

A few questions worth answering on paper:

• Do the doctors and hospitals I use take Original Medicare, and are they in the Advantage networks I would consider?
• Do I travel often or spend part of the year outside Arizona?
• How comfortable am I with prior authorization and referrals in exchange for extra benefits?
• If I want Medigap, am I inside a guaranteed-issue window, or would I be underwritten?

Arizona's State Health Insurance Assistance Program (SHIP) offers free, unbiased counseling and can walk through your specific situation.