Medicare 2026

Medicare in Nampa: the Medigap vs Advantage split

NAMPA, Idaho — If you are new to Medicare, or helping a parent sort it out, the first big fork in the road is almost always the same: stay with Original Medicare and add a Medigap policy, or move your coverage into a Medicare Advantage plan. The two paths look similar on a brochure, but they are built very differently — and knowing how they differ can save you a lot of confusion later.

Two different structures, not two flavors of the same thing

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 Medicare pays its share directly.

Medicare Advantage (Part C) is different. When you enroll in an Advantage plan, a private insurer takes over the job of delivering your Part A and Part B benefits. You are still in Medicare, but the plan sets the network, the rules for referrals, and the out-of-pocket limits.

That is the core structural difference. One is a government program you can add supplements to. The other bundles your coverage inside a private plan.

Where Medigap fits in

Original Medicare does not have a yearly cap on what you pay out of pocket. That is where Medigap (also called Medicare Supplement Insurance) comes in. Medigap policies are sold by private companies and are standardized by letter — Plan G and Plan N are common examples. They pick up costs like coinsurance and hospital deductibles that Original Medicare leaves to you.

A few things worth knowing about Medigap:

• It works only with Original Medicare, not with Medicare Advantage.
• It does not include drug coverage, so most people pair it with a stand-alone Part D plan.
• Your best pricing and guaranteed acceptance usually come during your one-time Medigap Open Enrollment Period, which starts the month your Part B begins.

How Medicare Advantage is put together

Medicare Advantage plans must cover everything Original Medicare covers, and most also include Part D drug coverage and extras like routine vision, dental, or hearing benefits. In exchange, you generally use the plan's network of doctors and hospitals and follow the plan's rules for things like prior authorization.

Advantage plans have a yearly cap on in-network out-of-pocket spending for Part A and Part B services — the amount is set each year by CMS. That built-in ceiling is one reason many people choose this path instead of adding a separate Medigap policy.

Nampa is in Canyon County, where residents typically have a wide selection of Medicare Advantage and Part D plans to compare each fall. The exact list is set at the county level and updates every year, so it is worth checking the Plan Finder at medicare.gov during enrollment season rather than relying on last year's options.

Drug coverage looks different on each path

On the Original Medicare + Medigap path, drug coverage is a separate decision — you sign up for a stand-alone Part D plan. On the Medicare Advantage path, drug coverage is usually built into the plan itself (these are called MA-PD plans).

The 2027 Part D rules are the same across the country:

• The out-of-pocket cap for covered drugs is $2,400.
• The maximum Part D deductible a plan can charge is $700.
• The old "donut hole" coverage gap is gone as of 2025; the benefit now has three phases.
• The Medicare Prescription Payment Plan lets you spread your drug costs into monthly payments if you choose.

Switching paths later — it is possible, with limits

You are not locked in forever. During the Annual Enrollment Period, Oct. 15 through Dec. 7, you can move between Original Medicare and Medicare Advantage, or change Part D plans. If you are already in a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period (Jan. 1 – March 31) lets you make one change — switch to a different Advantage plan or return to Original Medicare.

One catch to know about: if you leave Medicare Advantage and want to pick up a Medigap policy later, in most states you may have to answer health questions and could be turned down or charged more. That is why the initial decision deserves a careful look, even though it is not permanent.

Higher-income surcharges apply either way

Regardless of which path you choose, if your income is above certain thresholds you may pay an income-related monthly adjustment amount (IRMAA) on Part B and Part D. For 2026, IRMAA begins above $109,000 for a single filer (higher for married couples filing jointly). Social Security notifies you if it applies.