Medicare 2026

Two Ways to Get Medicare: Which Structure Fits You?

CICERO, Ill. — If you live in Cicero and you are getting close to Medicare age, or you are already on Medicare and rethinking your setup, you have likely heard two very different pitches. One is Original Medicare paired with a Medigap (supplement) policy. The other is Medicare Advantage, sometimes called Part C.

Two paths, one Medicare

Both are legitimate ways to receive your Medicare benefits. But they are built on different frames, and once you understand the frame, the trade-offs get a lot easier to see.

How Original Medicare plus Medigap is built

Original Medicare is the federal program itself. Part A covers hospital care, and Part B covers doctor visits and outpatient care. You can go to any doctor, hospital, or specialist in the country that accepts Medicare — and most do. There is no network and, in general, no referral needed to see a specialist.

The catch is that Original Medicare does not cap your out-of-pocket costs on its own. There is a Part A hospital deductible, a Part B deductible, and coinsurance that keeps going as long as you need care.

That is where Medigap comes in. A Medigap policy is sold by a private insurance company and is designed to pay some or most of those leftover costs — the deductibles, the coinsurance, and the copays that Original Medicare does not pay. You pay a monthly premium for the Medigap policy in exchange for more predictable bills at the point of care.

Two things to remember about Medigap:

• It does not include prescription drug coverage. If you want drug coverage, you add a stand-alone Part D plan.
• Your strongest guaranteed right to buy any Medigap policy sold in Illinois, regardless of health, is during your six-month Medigap Open Enrollment Period, which starts when you are 65 and enrolled in Part B. Outside that window, medical underwriting can apply in most states.

How Medicare Advantage is built

A Medicare Advantage plan is offered by a private insurance company that contracts with Medicare. When you enroll, you still have Medicare — but the plan takes over the job of paying for your Part A and Part B care, and it usually bundles in Part D drug coverage and sometimes extras like routine dental, vision, or hearing.

Advantage plans are network-based. Most are HMOs or PPOs, so the doctors and hospitals you can use, and how much you pay to use them, depend on the plan's network and rules. Referrals and prior authorization for certain services are common.

The trade-off: Advantage plans are required to have an annual out-of-pocket maximum for in-network medical care, which Original Medicare alone does not have. But you generally cannot pair a Medicare Advantage plan with a Medigap policy — the two systems are not designed to work together.

Cicero is in Cook County, where 58 Medicare Advantage plans from 11 carriers are available for 2027. Having a range of choices is helpful, but it also means the details — networks, drug lists, rules — vary a lot from plan to plan.

The 2027 drug coverage picture

Whichever path you pick, your prescription coverage matters. A few program-level facts to keep in mind for 2027:

• The Part D out-of-pocket cap is $2,100. Once your out-of-pocket spending on covered drugs reaches that amount, you pay $0 for covered drugs the rest of the year.
• The maximum Part D deductible is $615, though many plans set theirs lower.
• The old coverage gap, or "donut hole," was eliminated in 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 bills instead of paying large amounts at the pharmacy counter.

If you go with Original Medicare and Medigap, you'll choose a stand-alone Part D plan. If you go with Medicare Advantage, drug coverage is usually built into the plan.

How to think it through

There isn't a single right answer, but a few questions tend to sort it out:

• Do you travel or split time between states? Original Medicare's nationwide access can matter more than it looks on paper.
• Do you have specific doctors or a hospital system you want to keep? Check whether they are in an Advantage plan's network, or confirm they accept Medicare.
• How do you feel about predictable monthly premiums vs. paying more only when you use care? Medigap leans toward the first; Advantage often leans toward the second, with a safety net at the annual cap.
• Are you comfortable with plan rules like referrals and prior authorization? These are more common on the Advantage side.
• How is your income? IRMAA surcharges on Part B and Part D begin above $109,000 for a single filer in 2026. That applies on either path.

When you can make changes

Two dates to keep on your calendar:

• October 15 – December 7: Medicare's Annual Enrollment Period. You can join, switch, or drop a Medicare Advantage plan or a Part D plan, with changes taking effect January 1.
• January 1 – March 31: Medicare Advantage Open Enrollment. If you are already in an Advantage plan, you can switch to a different Advantage plan or go back to Original Medicare (and add a Part D plan) once during this window.

Switching from Advantage back to Original Medicare with a Medigap policy later on is legal, but Medigap underwriting rules may apply depending on your situation, so it is worth checking before you assume you can move freely between the two systems.