Medicare 2026

Medigap and Medicare Advantage compared for Lawrenceville

LAWRENCEVILLE, Ga. — If you're turning 65 soon, or helping a parent sort through the mail piling up on the kitchen counter, you've probably run into the big fork in the road: stick with Original Medicare and add a Medigap policy, or go with a Medicare Advantage plan?

Two very different roads to the same destination

Both paths cover the same core benefit — Medicare. But they're built very differently. Understanding that structure up front makes every other decision easier.

What Original Medicare + Medigap actually is

Original Medicare is the federal program itself: Part A (hospital) and Part B (doctor and outpatient). You can see any provider in the country who accepts Medicare, and most do. There's no network and no referrals.

Original Medicare pays most of your medical bills, but not all. You're responsible for deductibles and a 20% share of many Part B services, with no yearly cap on what you could owe.

That's where Medigap (also called Medicare Supplement Insurance) comes in. It's a private policy that pays some or all of what Original Medicare leaves behind — the deductibles, the coinsurance, the hospital copays. Medigap plans are standardized by letter (Plan G and Plan N are common examples), so a Plan G from one carrier covers the same medical items as a Plan G from another. Only the price and customer service differ.

One important note: Medigap does not include prescription drug coverage. If you go this route, you'll usually add a stand-alone Part D plan for medications.

What Medicare Advantage is

Medicare Advantage (Part C) is different in structure. You still have Medicare, but you receive your benefits through a private plan approved by Medicare instead of directly from the federal program. The plan handles your hospital, medical, and — in most cases — prescription drug coverage in one package.

Advantage plans typically use networks (HMO or PPO), and many require referrals or prior authorization for certain services. In exchange, they often bundle in extras that Original Medicare doesn't cover, such as routine dental, vision, or hearing benefits, along with an annual out-of-pocket maximum on medical costs.

Lawrenceville is in Gwinnett County, where a wide range of Medicare Advantage plans are offered each year. You can see the current lineup on Medicare's Plan Finder at medicare.gov.

The structural trade-off, in plain English

Think of it this way:

• Original Medicare + Medigap + Part D trades a higher, more predictable monthly cost for broad provider access and very light paperwork at the point of care. You go to almost any doctor in the U.S., show your cards, and the bills sort themselves out.
• Medicare Advantage trades network rules and plan-by-plan authorization for a lower monthly cost, an out-of-pocket cap, and bundled extras. You work within your plan's rules, and you use its network.

Neither is universally better. The right fit depends on your health, your doctors, your travel habits, and your budget.

Timing matters — especially for Medigap

Here's a wrinkle many people don't hear about until it's too late. When you first enroll in Part B at age 65, you get a six-month Medigap Open Enrollment Period. During that window, insurance companies must sell you a Medigap policy at their best available rate, regardless of your health.

Outside that window, in most states — Georgia included — Medigap insurers can use medical underwriting. That means they can charge you more, or turn you down, based on your health history. So if you start on Medicare Advantage and later decide you'd rather have Original Medicare + Medigap, switching may not be automatic.

The Medicare Advantage Open Enrollment Period (Jan. 1 – March 31) lets you switch Advantage plans or return to Original Medicare, but it doesn't guarantee you a Medigap policy. That's the part that catches people off guard.

2027 numbers worth knowing

Whichever path you choose, a few program-level figures apply across the board in 2027:

• The Part D out-of-pocket cap is $2,100 in 2026. Once your drug spending reaches that, you pay $0 for covered drugs the rest of the year.
• The Part D deductible maxes out at $615 in 2026 ($700 in 2027) (plans can charge less).
• The old "donut hole" is gone as of 2025 — Part D now has three phases instead of four.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the calendar year in monthly installments, at no extra charge, if that helps with cash flow.
• IRMAA — an income-based surcharge on Part B and Part D premiums — begins above $109,000 in income for a single filer in 2026.
• Annual Enrollment runs Oct. 15 – Dec. 7 each year for choosing or changing plans.