Medicare 2026

Two ways to fill Medicare's gaps in Westminster: how the paths actually differ

WESTMINSTER, Colo. — If you are new to Medicare, or rethinking your coverage this fall, you have really been handed one big structural choice: stick with Original Medicare and pair it with a Medigap policy (and usually a stand-alone drug plan), or move your coverage into a Medicare Advantage plan that bundles it all together. The monthly bill, the doctor network, the paperwork and the way a hospital stay gets paid all flow from that one decision.

This is not about which plan is "best." It is about how the two paths are built — because once you understand the plumbing, the trade-offs get much easier to see.

Path one: Original Medicare, usually with Medigap and a drug plan

Original Medicare is the federal program itself — Part A (hospital) and Part B (doctor and outpatient). You can see any doctor, hospital or specialist in the country that accepts Medicare, with no referrals. There is no network.

The catch is that Original Medicare alone does not cap what you pay out of pocket. That is why most people on this path add two things:

• A Medigap (Medicare Supplement) policy from a private insurer, which pays some or all of the deductibles and coinsurance Original Medicare leaves behind.
• A stand-alone Part D prescription drug plan, since Original Medicare does not include most outpatient drugs.

You pay a monthly premium for Part B, another for your Medigap policy, and another for your drug plan. In exchange, your care is predictable and portable — helpful if you travel, split time between states, or want to keep a specialist out of state.

Path two: Medicare Advantage (Part C)

Medicare Advantage is different in one big way: a private insurer takes over the job of paying your Part A and Part B claims, under contract with Medicare. You still have Medicare — you just get it delivered through the plan.

These plans usually:

• Use a network of doctors and hospitals (HMO or PPO), and may require referrals or prior authorization.
• Bundle in Part D drug coverage in most cases.
• Include an annual out-of-pocket maximum for medical care, which Original Medicare by itself does not have.
• Sometimes offer extras Original Medicare does not cover, such as routine dental, vision or hearing.

You keep paying your Part B premium, and you may pay an additional plan premium (or not, depending on the plan). Costs come as copays and coinsurance when you use care, rather than as a larger monthly Medigap premium.

The trade-off, in plain terms

The clearest way to see the difference:

• Original Medicare + Medigap tends to spread more of your cost into predictable monthly premiums, in exchange for very wide provider choice and fewer coverage decisions from an insurer.
• Medicare Advantage tends to keep monthly costs lower and add extras, in exchange for a network and more plan rules about how care is approved.

Neither is universally better. What matters is your doctors, your prescriptions, your travel patterns, your budget and how comfortable you are with either paperwork or networks.

What's the same on both paths in 2027

A few Medicare rules apply no matter which path you pick:

• Part D drug coverage — whether stand-alone or built into an Advantage plan — has a $2,100 out-of-pocket cap in 2026, and a deductible of up to $615.
• The old "donut hole" coverage gap was eliminated in 2025. Drug coverage now has three phases.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the calendar year in monthly installments, at no extra charge, on either path.
• Higher-income enrollees pay IRMAA surcharges on Part B and Part D. In 2026, those begin above $109,000 in income for a single filer.

How this looks in Westminster

Westminster sits in Adams County, and Medicare Advantage and Part D plan availability is set at the county level. That means the menu of plans a Westminster resident can shop is the same menu offered to everyone else in Adams County — not a city-specific list. When you use the Plan Finder at medicare.gov, entering your ZIP code pulls the correct county lineup.

Medigap works differently. Medigap policies are standardized by letter (Plan G, Plan N and so on) and sold by private insurers licensed in Colorado. The benefits inside a given letter are the same from company to company — a Plan G is a Plan G — but the premium and customer service are not. That is why shopping Medigap usually means comparing prices for the same lettered plan across insurers.

Timing matters — maybe more than the plan itself

Two dates drive most Medicare decisions:

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

Medigap has its own rules. When you first sign up for Part B at 65, you get a six-month Medigap Open Enrollment window during which insurers must sell you any policy they offer at their best rate, regardless of health history. Outside that window — and outside certain guaranteed-issue situations — insurers in most states, including Colorado, can use medical underwriting. That is a big reason the "switch from Advantage back to Medigap later" plan does not always work the way people expect.