Medicare 2026

Medigap and Medicare Advantage: two builds, Aurora

AURORA, Ill. — Every fall, people turning 65 in Aurora sit at the kitchen table with a stack of mail and the same basic question: should I stay with Original Medicare and add a Medigap policy, or should I go with a Medicare Advantage plan? The answer isn't the same for everyone, but the choice itself becomes a lot clearer once you understand how the two paths are built.

Two paths, same starting point

Everyone on Medicare starts with the same building blocks: Part A (hospital) and Part B (doctor and outpatient). From there, the federal government lets you go one of two directions.

Path 1: Original Medicare + Medigap (+ usually Part D). You keep Parts A and B directly from the federal Medicare program. You can add a stand-alone Medigap policy (also called Medicare Supplement) from a private insurer to help cover the deductibles and coinsurance Original Medicare doesn't pay. Because Original Medicare doesn't include most prescription drug coverage, you typically add a separate Part D drug plan.

Path 2: Medicare Advantage (Part C). You still have Medicare, but you get your Part A and Part B benefits through a private plan approved by Medicare. Most Medicare Advantage plans also include Part D drug coverage bundled in, and many include extras that Original Medicare doesn't cover.

You generally cannot combine the two. If you enroll in a Medicare Advantage plan, you can't also use a Medigap policy.

How Original Medicare + Medigap works

Under Original Medicare, you can see any doctor or hospital in the country that accepts Medicare — and most do. There are no network restrictions and no referrals to see a specialist.

Original Medicare on its own leaves gaps: a Part A hospital deductible, 20% coinsurance for most Part B services, and no annual out-of-pocket cap. Medigap policies are designed to fill in those gaps. They are sold by private insurers but standardized by letter (Plan G, Plan N, and so on), meaning a Plan G from one company covers the same core benefits as a Plan G from another. Price and customer service can differ, but the benefits inside a lettered plan don't.

One important detail: when you first become eligible for Medicare Part B at 65, you have a six-month Medigap Open Enrollment Period. During that window, insurers must sell you any Medigap policy they offer at their best available rate, regardless of your health history. Outside that window, in most states, insurers can use medical underwriting.

How Medicare Advantage works

Medicare Advantage plans are offered by private insurers under contract with Medicare. They're required to cover everything Original Medicare covers, and most also include prescription drug coverage and additional benefits such as routine vision, dental, hearing, or fitness programs. Every Medicare Advantage plan has a yearly cap on in-network out-of-pocket costs, which Original Medicare alone does not.

The trade-off is structure. Most plans are HMOs or PPOs, so you'll usually have a provider network, and some services may require prior authorization or a referral. If you travel often or split time between states, that's worth thinking through.

Aurora is in Kane County, where a number of Medicare Advantage plans from multiple carriers are available for 2026. The specific count changes year to year, so it's worth checking the Plan Finder at medicare.gov during Open Enrollment to see the current lineup.

What's changing in 2027

Both paths are affected by the same program-level rules for Part D drug coverage:

• The out-of-pocket cap on covered Part D drugs is $2,100 in 2026. Once you hit it, you pay $0 for covered drugs the rest of the year.
• The maximum Part D deductible is $615.
• The old "donut hole" coverage gap is gone as of 2025 — Part D now has three phases (deductible, initial coverage, catastrophic).
• The Medicare Prescription Payment Plan lets you spread your drug costs across the year in monthly installments instead of paying at the pharmacy counter, if that helps with cash flow.
• IRMAA — the income-related surcharge on Part B and Part D premiums — starts above $109,000 in income for a single filer in 2026.

These rules apply whether you get your drug coverage through a stand-alone Part D plan or bundled inside a Medicare Advantage plan.

Deadlines to keep on the calendar

• Annual Enrollment Period: Oct. 15 – Dec. 7. This is when anyone with Medicare 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're already in a Medicare Advantage plan, you can switch to a different one or return to Original Medicare (and pick up a Part D plan) once during this window.

If you're new to Medicare, your Initial Enrollment Period is built around your 65th birthday — three months before, the month of, and three months after.

Which path fits you?

There's no universal "right" answer, and honesty is the point: this is a personal decision that depends on your doctors, your prescriptions, your budget, how much you travel, and how you feel about paperwork versus predictability. Some people value the freedom of Original Medicare + Medigap and are willing to pay a monthly premium for it. Others prefer the bundled simplicity of Medicare Advantage and the extra benefits many plans include.

For unbiased help comparing your options in Aurora, Illinois' SHIP program (called SHIP here, run through the state Department on Aging) offers free one-on-one counseling. You can also compare plans and coverage at medicare.gov or call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week.