Medicare 2026

Medicare Advantage vs Medigap structure for Newark readers

NEWARK, Del. — If you are approaching Medicare age in Newark, or helping a parent think it through, you have probably heard two very different pitches. One path keeps you in Original Medicare and adds a Medigap policy. The other moves your coverage into a Medicare Advantage plan. Both are legal, both are common, and both are built on the same underlying program — but they are structured very differently, and understanding that structure is the key to picking the path that fits your life.

The two paths, side by side

Path 1: Original Medicare + Medigap (+ usually a Part D plan). Original Medicare is the federal program itself — Part A (hospital) and Part B (doctor and outpatient). You can see any doctor or hospital in the country that accepts Medicare, with no network and no referrals. Original Medicare, though, has deductibles and coinsurance with no yearly out-of-pocket cap. That is where a Medigap (Medicare Supplement) policy comes in: a private policy that helps pay the gaps Original Medicare leaves behind. Because Original Medicare and Medigap do not include prescription coverage, most people on this path also sign up for a stand-alone Part D drug plan.

Path 2: Medicare Advantage (Part C). Medicare Advantage is a private plan, approved by Medicare, that delivers your Part A and Part B benefits in one bundle. Most Advantage plans also include Part D drug coverage and may include extras Original Medicare does not cover. In exchange, these plans usually operate through a network (HMO or PPO), and cost-sharing works differently than under Original Medicare. You cannot use a Medigap policy with a Medicare Advantage plan — the two paths do not mix.

How the money is structured

The two paths handle costs in fundamentally different ways.

Under Original Medicare + Medigap, you pay your Part B premium, a Medigap premium, and a Part D premium. In return, most of your covered medical costs are predictable — the Medigap policy absorbs a lot of the day-to-day cost-sharing.

Under Medicare Advantage, you still pay your Part B premium, plus whatever the plan charges. Instead of predictable Medigap-style coverage, you pay copays or coinsurance as you use services, up to an annual out-of-pocket maximum that every Advantage plan is required to have.

Neither path is automatically cheaper. Which one costs less over a year depends on your health, your prescriptions, and how often you use care.

What is new for 2027

A few program-level updates are worth knowing, no matter which path you consider:

• Part D out-of-pocket cap of $2,400 in 2027. Once your drug spending reaches that amount, you pay nothing for covered Part D drugs the rest of the year (the 2026 cap is $2,100).
• Part D deductible capped at $700 in 2027. Individual plans may charge less, but not more (the 2026 cap is $615).
• No more “donut hole.” As of 2025, the coverage gap phase is gone; Part D now has three phases instead of four.
• Medicare Prescription Payment Plan. This optional program lets you spread your drug costs across the calendar year in monthly payments instead of paying at the pharmacy counter.
• IRMAA. Higher-income enrollees pay surcharges on Part B and Part D premiums; in 2026, IRMAA begins above $109,000 in income for a single filer.

What is available around Newark

Newark is in New Castle County, where residents can compare the Medicare Advantage and Part D plans offered in that county. Availability, provider networks, and drug formularies are set at the county level, so a neighbor a few miles away in a different county may see a slightly different list. The Medicare Plan Finder at medicare.gov lets you type in your ZIP code and see exactly what is offered where you live.

When you can make the choice

Most people first pick a path during their Initial Enrollment Period, the seven-month window around their 65th birthday. After that, the two main windows are:

• Annual Enrollment Period: Oct. 15 – Dec. 7. You can join, switch, or drop a Medicare Advantage or Part D plan. Changes take effect Jan. 1.
• 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 note: switching from Medicare Advantage back to Original Medicare + Medigap later in life is allowed, but in most states — including Delaware outside of specific guaranteed-issue situations — Medigap insurers can use medical underwriting. That means your health history can affect whether, and at what price, you can get a Medigap policy after your initial window. It is worth understanding this before you choose a path, not after.