Medicare 2026
Two Medicare paths, one big decision before Dec. 7
SAN MATEO, Calif. — If you are turning 65 soon, or already on Medicare and rethinking your coverage before the Dec. 7 enrollment deadline, you are really choosing between two very different structures. One path is Original Medicare, often paired with a Medigap (supplement) policy and a stand-alone Part D drug plan. The other is Medicare Advantage, which bundles your coverage through a private plan. They can look similar on a brochure, but under the hood they work in very different ways.
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Key takeaways
- Original Medicare plus a Medigap policy is a federal-plus-private combo that lets you see any provider who accepts Medicare, usually with a separate Part D drug plan.
- Medicare Advantage is a single private plan that replaces how Original Medicare pays your claims and often includes drug coverage and extra benefits, but uses a network.
- In 2026, Part D has a $2,100 out-of-pocket cap and up to a $615 deductible; in 2027, the cap is $2,400 and the maximum deductible is $700, no matter which path you take for drug coverage.
- Annual Enrollment runs Oct. 15–Dec. 7, and Medicare Advantage Open Enrollment runs Jan. 1–March 31 for people already in an Advantage plan.
Here is a plain-English look at how each path is built, so you can think it through before you sign anything.
How Original Medicare plus Medigap is built
Original Medicare is the federal program itself: Part A (hospital) and Part B (doctor and outpatient). You can go to any doctor, hospital, or specialist in the country who accepts Medicare. There is no network and no referral needed.
But Original Medicare alone leaves gaps — deductibles, the 20% coinsurance on Part B, and no yearly out-of-pocket limit. That is where a Medigap policy comes in. Medigap is sold by private insurers and is standardized by letter (Plan G, Plan N, and so on). It pays some or most of what Original Medicare leaves behind.
Because Original Medicare and Medigap do not include drug coverage, most people on this path also buy a stand-alone Part D plan.
How Medicare Advantage is built
Medicare Advantage (Part C) is different. You still have Medicare, but a private company takes over the job of paying your claims and setting your rules. Most Advantage plans are HMOs or PPOs, meaning you generally use a network of doctors and hospitals, and some services need prior approval.
Advantage plans usually bundle Part D drug coverage into the same plan and often add extras like dental, vision, hearing, or fitness benefits. Every Advantage plan is required to have a yearly cap on in-network medical out-of-pocket costs — a limit Original Medicare by itself does not include.
San Mateo is in San Mateo County, where multiple Medicare Advantage plans and carriers are offered each year. The exact count changes annually, and you can see the current list at medicare.gov using your ZIP code.
The trade-off in one sentence
Original Medicare with Medigap tends to mean broader provider choice and more predictable bills, with a higher monthly premium. Medicare Advantage tends to mean lower or no extra monthly premium and built-in extras, in exchange for a network and plan rules. Neither is "better" — they are built for different priorities.
Drug coverage works the same under Part D rules
Whichever path you pick, Part D has the same guardrails in 2026:
- An annual out-of-pocket cap on covered drugs of $2,100 in 2026 and $2,400 in 2027.
- A maximum deductible of $615 in 2026 and $700 in 2027 (many plans set it lower).
- No more coverage gap — the old "donut hole" was eliminated in 2025, and Part D now has three phases.
- The optional Medicare Prescription Payment Plan, which lets you spread drug costs into monthly payments instead of paying big amounts at the pharmacy counter.
Higher-income beneficiaries may also pay an IRMAA surcharge on Part B and Part D. For 2026, IRMAA starts above $109,000 in income for a single filer (based on your tax return from two years earlier).
Watch the Medigap timing
One structural detail that catches people off guard: Medigap has its own enrollment rules. When you first enroll in Part B at 65, you get a six-month Medigap Open Enrollment Period during which insurers cannot turn you down or charge more for health reasons. Outside that window, in most states, Medigap insurers can use medical underwriting.
That means switching from Medicare Advantage back to Original Medicare plus Medigap later in life is not always easy. It is worth thinking about up front, not after a health change.
Dates to keep on your calendar
- Oct. 15 – Dec. 7: Medicare Annual Enrollment. Anyone with Medicare can join, switch, or drop a Medicare Advantage or Part D plan for the coming year.
- Jan. 1 – March 31: Medicare Advantage Open Enrollment. If you are already in an Advantage plan, you can switch to another Advantage plan or return to Original Medicare (and pick up a Part D plan).
By the numbers
Medicare Part B premium, 2006–2026
The standard monthly Part B premium has climbed from $88.50 in 2006 to $202.90 in 2026. Hover any point for that year’s premium.
Source: CMS. Standard premium shown; in some hold-harmless years many existing enrollees paid less. Confirm at Medicare.gov.
By the numbers
How people get Medicare in San Mateo County
(MA penetration in San Mateo County)
MA penetration from CMS enrollment data; Medigap share is an estimate. U.S. average is about 54% Medicare Advantage. These are area-level figures, not plan-specific.
Explore
When can you enroll? An interactive year
Enrollment windows are federal and the same nationwide. Confirm your personal dates at Medicare.gov or 1-800-MEDICARE.
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The parts of Medicare
Good to know
Frequently asked questions
Can I have both Medigap and Medicare Advantage at the same time?
Do I need a separate drug plan on Medicare Advantage?
What happens if I do nothing during Annual Enrollment?
Where can I get unbiased help comparing the two paths?
- CMS — Medicare basics (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.
Also for San Mateo
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This page was last updated: September 29, 2026.