Medicare 2026

Medicare structure choices facing Meridian residents at 65

For people turning 65 in Meridian — or rethinking their coverage during Medicare's fall enrollment window — the biggest choice usually comes down to structure. Do you want Original Medicare paired with a Medigap policy, or do you want a Medicare Advantage plan? They cover the same core benefits in very different ways, and understanding the difference upfront can save a lot of second-guessing later.

The two paths, in plain language

Original Medicare is the federal program itself — Part A (hospital) and Part B (doctor and outpatient). You can see any provider in the country that accepts Medicare, and there's no network. But Original Medicare doesn't cap your yearly out-of-pocket spending on its own, and it doesn't include prescription drug coverage.

That's where Medigap (also called Medicare Supplement Insurance) comes in. A Medigap policy is sold by a private insurer and helps pay the deductibles, copays, and coinsurance Original Medicare leaves behind. To get drug coverage, you add a standalone Part D plan.

Medicare Advantage (Part C) is different in structure. Instead of layering pieces, you get your Part A and Part B benefits — and usually Part D drug coverage — through a single private plan approved by Medicare. These plans typically use provider networks (HMO or PPO), have their own cost-sharing rules, and often include extras like dental, vision, or hearing. Every Medicare Advantage plan has a yearly out-of-pocket maximum for medical services.

How costs are structured

With Original Medicare + Medigap, you're generally paying more in predictable monthly premiums (Part B, Medigap, Part D) in exchange for very low surprise costs at the point of care. With Medicare Advantage, premiums can be lower, but you may pay copays or coinsurance each time you use services, up to that plan's annual maximum.

Neither path is universally cheaper. It depends on how often you use care, which doctors you see, and what medications you take.

What's changing for 2027

A few program-level updates matter no matter which path you choose:

• Part D out-of-pocket cap: $2,100 in 2026 and $2,400 in 2027. Once you hit it, you pay nothing for covered drugs the rest of the year.
• Part D deductible: capped at $615 in 2026 and $700 in 2027.
• No more donut hole. The coverage gap phase was eliminated in 2025, so Part D now has three phases instead of four.
• Medicare Prescription Payment Plan. You can opt in to spread your yearly drug costs into monthly payments instead of paying big bills at the pharmacy counter.
• IRMAA (higher Part B and Part D premiums for higher incomes) starts above $109,000 for a single filer in 2026.

What this looks like in Meridian

Meridian sits in Ada County, where Medicare plan availability is set at the county level. That means whether you live near The Village, in north Meridian, or out toward Eagle Road, the same menu of Medicare Advantage plans and Part D plans is available to you. Medigap policies, on the other hand, are regulated by the Idaho Department of Insurance and are generally available statewide, though pricing and underwriting rules vary by insurer and your situation.

One important Medigap note: when you first become eligible for Medicare at 65, you have a six-month Medigap Open Enrollment Period during which insurers can't turn you down or charge more based on health. Outside that window, in most cases, they can. This is one of the biggest structural reasons people think carefully before switching between the two paths later on.

Enrollment windows to know

• Initial Enrollment Period: the seven months around your 65th birthday.
• Annual Enrollment Period: Oct. 15 – Dec. 7 each year. You can join, switch, or drop Medicare Advantage and Part D plans.
• Medicare Advantage Open Enrollment: Jan. 1 – March 31. If you're already in a Medicare Advantage plan, you get one chance to switch to another or return to Original Medicare.

How to think it through

A few questions that tend to clarify the choice:

• Do you travel often or split time between states? Original Medicare's nationwide access may matter more.
• Do you have specific doctors or specialists you want to keep? Check whether they're in a plan's network before enrolling in Medicare Advantage.
• Are you comfortable paying more each month for fewer surprises, or would you rather pay less monthly and share costs as you go?
• Do you take prescriptions? Compare each plan's drug formulary — not just the premium.

There's no universally right answer. There's a right answer for you.

Where to get unbiased help

For personalized guidance, Idahoans can contact SHIBA (Senior Health Insurance Benefits Advisors), Idaho's State Health Insurance Assistance Program. Counselors are trained volunteers and don't sell plans. You can also call 1-800-MEDICARE (1-800-633-4227), 24/7, or use the plan finder at medicare.gov.