Medicare 2026

Medicare Advantage or Medigap? Understanding Two Paths

HARTFORD, Conn. — If you're turning 65 in Hartford or helping a parent sort through Medicare mail, you've probably noticed the choice comes down to two very different roads. One is Original Medicare, often paired with a Medigap policy and a separate drug plan. The other is Medicare Advantage, which bundles things together through a private insurer.

They can look similar on the surface. Structurally, they are not the same — and understanding the difference now can save you a lot of frustration later.

The two paths, in plain English

Path 1: Original Medicare (+ Medigap + Part D). This is the federal program itself. Part A covers hospital stays, Part B covers doctor visits and outpatient care. You can see any doctor or hospital in the country that accepts Medicare, and most do. Because Original Medicare leaves gaps — deductibles, coinsurance, no out-of-pocket limit — many people add a Medigap (Medicare Supplement) policy from a private company to help cover those costs. Drug coverage comes separately through a stand-alone Part D plan.

Path 2: Medicare Advantage (Part C). This is a private plan approved by Medicare that replaces how you receive your Part A and Part B benefits. Most Advantage plans also include Part D drug coverage and extras like dental, vision, or hearing. In exchange, you usually stay inside a network (HMO or PPO), and you may need referrals or prior authorization for certain services.

Neither path is "better." They're built differently, and they suit different lives.

How the money works differently

With Original Medicare + Medigap, you generally pay a monthly Medigap premium on top of your Part B premium, plus a Part D premium. In return, your out-of-pocket costs when you actually use care tend to be more predictable.

With Medicare Advantage, premiums are often lower, but you pay copays and coinsurance as you use services, up to the plan's annual out-of-pocket maximum. Costs are lower when you're healthy and can climb when you're not.

One thing that's the same on both paths in 2026: your Part D drug costs are capped at $2,100 out of pocket for the year, the coverage gap ("donut hole") is gone, and the Part D deductible can be no more than $615. You can also opt into the Medicare Prescription Payment Plan to spread drug costs across the calendar year instead of paying big bills up front. These rules come from CMS and apply whether your drug coverage is stand-alone or built into an Advantage plan.

Doctors, networks, and travel

This is where the two paths feel most different day to day.

• Original Medicare has no network. If a provider accepts Medicare — in Hartford, in Florida, in Oregon — you're covered.
• Medicare Advantage plans use networks. Some are HMOs (in-network only, except emergencies). Some are PPOs (out-of-network care allowed at higher cost). Networks can change year to year.

If you split time between Connecticut and another state, travel often, or want to keep a specialist at a major medical center without checking a directory, that matters. If you mostly see local doctors and like extras bundled in, a network plan may feel fine.

Local context: Hartford County

Hartford is in Hartford County, and Medicare Advantage and Part D plan availability is set at the county level. Every year, the number of plans, the carriers offering them, and the benefits inside those plans can shift. That's why the pre-enrollment mail gets heavy each fall — and why comparing plans on Medicare.gov using your own ZIP code, doctors, and prescriptions gives you a far more accurate picture than any brochure.

Star Ratings, which CMS publishes annually, can tell you how a plan has performed on quality measures. They're a useful data point, not a shortcut.

The mistake to avoid: waiting too long on Medigap

Here's the part many people learn the hard way. When you first enroll in Part B at 65, you get a six-month Medigap Open Enrollment window. During that window, insurers must sell you a Medigap policy regardless of your health.

After that window closes, in most states insurers can use medical underwriting — meaning they can charge more or decline you based on your health history. Connecticut has some of the more consumer-friendly Medigap rules in the country, but the safest moment to buy a Medigap policy is still that first window.

This matters because people sometimes start on Medicare Advantage, then try to switch to Original Medicare + Medigap years later when their health changes. The switch back to Original Medicare is allowed, but getting a Medigap policy at that point may not be guaranteed. Know the rules before you choose the path.

Key dates to remember

• Annual Enrollment Period: October 15 – December 7. You can join, switch, or drop a Medicare Advantage or Part D plan for the following year.
• Medicare Advantage Open Enrollment: January 1 – March 31. If you're 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).
• IRMAA: Higher-income beneficiaries pay surcharges on Part B and Part D. In 2026, those surcharges begin above $109,000 in income for a single filer, based on your tax return from two years earlier.