Medicare 2026

Before You Pick Medicare, Know How the Two Sides Work

MOUNT PROSPECT, Ill. — When you first sign up for Medicare, you face a fork in the road that shapes how you'll get care for years to come. One path keeps you on Original Medicare and adds a Medigap policy to help with the gaps. The other path moves your coverage over to a private Medicare Advantage plan. Both are legitimate. But they work in very different ways, and knowing the structure before you pick can save you a lot of frustration later.

The two structures, side by side

Original Medicare is the federal program. Part A covers hospital stays, and Part B covers doctor visits and outpatient care. You can go to any doctor or hospital in the country that accepts Medicare — no network, no referrals. But Original Medicare doesn't cap your out-of-pocket costs, and it doesn't include prescription drugs.

That's where the add-ons come in. A Medigap policy (also called Medicare Supplement Insurance) is sold by a private company and helps pay the deductibles, copays, and coinsurance Original Medicare leaves behind. You'd typically also add a stand-alone Part D drug plan.

Medicare Advantage (Part C) is different. It's still Medicare, but the government pays a private insurer to manage your benefits. The plan replaces Original Medicare as your day-to-day coverage. It usually includes prescription drug coverage and often adds extras like dental or vision. In exchange, you use the plan's network of doctors and follow its rules.

Networks and referrals

This is where many people get tripped up. With Original Medicare plus Medigap, you can walk into almost any hospital or specialist in the country and be covered.

Medicare Advantage plans, on the other hand, are usually HMOs or PPOs. HMOs generally require you to stay in-network and get referrals for specialists. PPOs are more flexible but still charge more for out-of-network care. If you travel often, split time between states, or want a specific specialist far from home, the network question matters.

What each path costs you (in structure, not dollars)

We can't quote plan prices here, but the shape of the costs is important.

With Original Medicare, you pay the Part B premium, plus a Medigap premium, plus a Part D premium. In return, most of your medical bills are predictable — the Medigap policy smooths them out.

With Medicare Advantage, you still pay the Part B premium, and you may pay a plan premium. Your medical costs come as copays and coinsurance as you use care, up to an annual out-of-pocket maximum the plan is required to set for Part A and Part B services.

Prescription drugs in 2027

Drug coverage rules apply either way, and 2027 brings further changes. The Part D out-of-pocket cap rises to $2,400 for the year, up from $2,100 in 2026, and the maximum Part D deductible is $700 in 2027. The old coverage gap or "donut hole" is gone — replaced by a simpler three-phase design that started in 2025. Medicare also offers the Medicare Prescription Payment Plan, which lets you spread drug costs across the year in monthly payments instead of paying at the pharmacy counter.

Higher-income enrollees should know that IRMAA surcharges on Part B and Part D begin above $109,000 in income for a single filer in 2026.

What's available around Mount Prospect

Mount Prospect is in Cook County, where Medicare beneficiaries have a wide range of Medicare Advantage plans and stand-alone Part D plans to choose from, offered by multiple carriers. Medigap policies are also sold across Illinois, with standardized letter-based plans (like Plan G or Plan N) that offer the same core benefits no matter which insurer sells them.

Because availability is set at the county level, two neighbors on opposite sides of a county line can see different plan menus. When you compare, use your ZIP code on the official Plan Finder at medicare.gov so you're looking at what's actually offered where you live.

Key dates to remember

The Annual Enrollment Period runs Oct. 15 through Dec. 7 each year. That's when anyone with Medicare can join, drop, or switch a Medicare Advantage plan or a Part D plan.

If you're already in a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period from Jan. 1 through March 31 gives you one more chance to switch to a different Advantage plan or return to Original Medicare.

Medigap has its own timing rules. Your best window to buy a Medigap policy without medical underwriting is generally the six-month Medigap Open Enrollment Period that begins when you're 65 or older and enrolled in Part B. Outside that window, insurers in most states can review your health history before selling you a policy.