Medicare 2026

Medicare in Goshen: two systems built very differently

GOSHEN, Ind. — When people first sign up for Medicare, one question tends to cause more confusion than any other: should you stay with Original Medicare and add a Medigap policy, or should you go with a Medicare Advantage plan? Both are legitimate, both are common, and both are built very differently. Understanding that difference before you enroll can save you a lot of headaches later.

Here in Goshen, folks turning 65 usually hear about both paths from friends, neighbors, and a steady stream of mailers. This guide walks through how each one is actually structured — so you can ask better questions before you pick.

Two different roads, not two versions of the same thing

Original Medicare is the traditional, federally run program. It has two parts: Part A (hospital coverage) and Part B (doctor and outpatient coverage). You can go to almost any doctor or hospital in the country that accepts Medicare, and there's no network to worry about.

Medicare Advantage (also called Part C) is different. It's private insurance that replaces the way you get your Part A and Part B benefits. The federal government pays a private company to manage your coverage, and that company sets the rules — the network of doctors, the referral requirements, the prior authorizations, and often the prescription drug coverage too.

So the first big idea to hold onto: Original Medicare and Medicare Advantage are two separate ways to receive your Medicare benefits, not two flavors of the same plan.

Where Medigap fits in

If you stick with Original Medicare, you'll notice pretty quickly that it doesn't cover everything. There are deductibles, and Part B generally pays 80% of covered services, leaving you responsible for the other 20% — with no yearly cap on what you might spend.

That's what Medigap (also called Medicare Supplement Insurance) is for. Medigap is a separate private policy that fills in some of those out-of-pocket costs. Medigap policies are standardized by letter (Plan G, Plan N, and others), so a Plan G from one company covers the same core things as a Plan G from another.

A few points worth knowing:

• Medigap only works with Original Medicare. You cannot use it with a Medicare Advantage plan.
• Medigap does not include prescription drug coverage. If you go this route, you'll usually add a stand-alone Part D drug plan.
• The best time to buy a Medigap policy is during your six-month Medigap Open Enrollment Period, which starts when you're 65 and enrolled in Part B. During that window, insurers can't turn you down or charge you more for health reasons. Outside of it, in most states, they can.

How Medicare Advantage is put together

Medicare Advantage plans bundle things differently. A single plan usually includes Part A, Part B, and Part D drug coverage, and many plans add extras like routine dental, vision, or hearing benefits. Instead of paying separate premiums for a supplement and a drug plan, you have one plan.

The trade-offs are structural:

• Networks matter. Most Advantage plans are HMOs or PPOs. You may need to use in-network providers, and HMOs often require referrals.
• Prior authorization is common. The plan may require approval before certain services are covered.
• There's a yearly out-of-pocket maximum for medical services, which Original Medicare alone doesn't have.
• Plans change every year. Benefits, networks, and drug lists can shift each January, so it pays to read the Annual Notice of Change your plan mails in the fall.

Goshen is in Elkhart County, where residents typically have a range of Medicare Advantage plans and stand-alone Part D drug plans to choose from. The exact number of options changes year to year, and you can see the current list for your ZIP code using the Plan Finder tool at Medicare.gov.

The 2027 drug coverage picture

Whether you go with Original Medicare + a Part D plan or a Medicare Advantage plan that includes drugs, some Part D rules apply across the board in 2027:

• The out-of-pocket cap for Part D is $2,100 in 2026 and $2,400 in 2027. Once your covered drug spending reaches that amount, you pay nothing more for covered drugs the rest of the year.
• The maximum Part D deductible is $615 in 2026 and $700 in 2027. Plans can set a lower deductible, but not higher.
• The old "donut hole" is gone. As of 2025, Part D has three phases — deductible, initial coverage, and catastrophic — with no coverage gap.
• The Medicare Prescription Payment Plan lets you spread your out-of-pocket drug costs across the calendar year in monthly payments instead of paying at the pharmacy counter. It's optional and free to join.

Higher-income beneficiaries should also know about IRMAA — an income-related surcharge on Part B and Part D premiums that begins above $109,000 in income for a single filer in 2026.

The mistake to avoid

The most common mistake people make isn't picking the "wrong" path — it's picking without understanding the trade-offs.

If you value freedom to see any Medicare provider and predictable coverage rules, Original Medicare with a Medigap policy is built for that. You'll pay more in monthly premiums but usually less at the point of care.

If you value lower monthly premiums, extra benefits, and having everything under one plan, Medicare Advantage is built for that. You'll work within a network and follow the plan's rules.

The critical thing: switching later isn't always easy. If you start with Medicare Advantage and later try to move to Original Medicare with a Medigap policy, you may face medical underwriting depending on your state and timing — meaning the Medigap insurer can consider your health. That's why the initial decision matters so much.

Key dates to keep on the calendar

• Annual Enrollment Period: October 15 – December 7 each year. This is when anyone with Medicare can join, drop, or switch Part D and Medicare Advantage plans for the following year.
• Medicare Advantage Open Enrollment Period: January 1 – March 31. If you're already in a Medicare Advantage plan, you get one chance during this window to switch to a different Advantage plan or return to Original Medicare (and add a Part D plan).
• Medigap Open Enrollment: A six-month window that starts the month you're 65 and enrolled in Part B.