Medicare 2026

How Medigap Letter Plans Work for Smyrna Medicare

SMYRNA, Del. — If you're turning 65 in Smyrna, or helping a parent sort out coverage, the biggest choice usually comes down to this: stay with Original Medicare and add a Medigap policy, or pick a Medicare Advantage plan instead. The two paths are built very differently, and understanding how they're put together is more useful than comparing any single plan.

Two ways Medicare is delivered

Original Medicare is the federal program itself. Part A covers hospital stays, and Part B covers doctor visits and outpatient care. You can see any provider in the country who accepts Medicare — no network, no referrals. But Original Medicare doesn't cap what you pay out of pocket, which is why most people add either a Medigap (Medicare Supplement) policy, a standalone Part D drug plan, or both.

Medicare Advantage, sometimes called Part C, is different. You're still in Medicare, but a private insurer administers your benefits under contract with the federal government. Advantage plans usually use provider networks (HMO or PPO), often include Part D drug coverage, and may bundle in extras. They also set their own rules for prior authorization and referrals.

You cannot combine the two. If you enroll in a Medicare Advantage plan, your Medigap policy won't pay for services under it.

How Medigap fits with Original Medicare

Medigap policies are sold by private insurers but standardized by the federal government, so a Plan G from one carrier covers the same core items as a Plan G from another. Medigap helps pay the deductibles, coinsurance, and copays that Original Medicare leaves to you.

The best time to buy a Medigap policy is during your six-month Medigap Open Enrollment Period, which starts the month you're 65 and enrolled in Part B. During that window, insurers can't turn you down or charge more for health reasons. Outside it, Delaware follows federal rules, and medical underwriting may apply.

How Medicare Advantage is structured

Advantage plans have an annual out-of-pocket maximum for Part A and B services — a built-in ceiling Original Medicare doesn't have on its own. In exchange, you generally agree to use the plan's network and follow its coverage rules.

Smyrna is in Kent County, where Delaware residents have a range of Medicare Advantage plans and standalone Part D plans to compare each year. Availability and plan details change annually, so it's worth checking during the Annual Enrollment Period even if you're happy with your current coverage.

Drug coverage in 2027

Prescription drug coverage matters no matter which path you choose. In 2027, Part D plans cannot charge more than a $700 deductible, and once you hit $2,400 in out-of-pocket drug costs, you pay nothing more for covered drugs the rest of the year. The old "donut hole" was eliminated in 2025, so Part D now has three phases instead of four.

If big pharmacy bills hit early in the year, the Medicare Prescription Payment Plan lets you spread those costs across monthly payments instead of paying all at once at the counter. It's optional and doesn't change what you owe overall.

Higher-income surcharges

Both Part B and Part D can carry an income-related monthly adjustment amount (IRMAA). For 2026, IRMAA begins for single filers with income above $109,000 (based on your tax return from two years earlier). This applies whether you're on Original Medicare or a Medicare Advantage plan that includes drug coverage.

Key dates to remember

• Oct. 15 – Dec. 7: Annual Enrollment Period. You can join, switch, or drop a Medicare Advantage or Part D plan.
• Jan. 1 – March 31: Medicare Advantage Open Enrollment. If you're already in an Advantage plan, you get one chance to switch to another or return to Original Medicare.
• Your Medigap Open Enrollment Period: Six months starting when you're 65 and enrolled in Part B.