Medicare 2026

The built-in differences of Medicare plans in Iowa City

Iowa City, Iowa — Picking between Original Medicare with a Medigap policy and a Medicare Advantage plan is one of the biggest choices you'll make when you sign up. The two paths cover the same core benefits, but they are built very differently. Understanding that structure — not just the price tag — is the key to a choice you can live with for years.

Two different structures, same starting point

Everyone with Medicare starts with the same building blocks: Part A (hospital) and Part B (doctor and outpatient). From there, the roads split.

With Original Medicare, you stay in the federal program. You can see any doctor or hospital in the country that accepts Medicare — and most do. Medicare pays its share, and you're responsible for the rest, which includes deductibles and a 20% coinsurance on most Part B services. There's no yearly cap on what you could spend out of pocket.

With Medicare Advantage (Part C), you're still in Medicare, but a private insurance company manages your benefits. These plans typically use networks (HMO or PPO), often require referrals or prior authorization, and set their own copays. They must cap your yearly out-of-pocket costs for Part A and B services, and many bundle in drug coverage and extras like dental or vision.

Where Medigap fits in

Medigap (also called Medicare Supplement Insurance) is a separate private policy that pairs only with Original Medicare. It pays some or all of the coinsurance, copayments, and deductibles that Original Medicare leaves behind. Medigap plans are standardized and labeled by letter (Plan G, Plan N, and others), so a Plan G from one company covers the same things as a Plan G from another — the price and customer service are what differ.

One important detail: you cannot use a Medigap policy with a Medicare Advantage plan. It's one or the other.

Another detail worth knowing early: when you first enroll in Part B at age 65, you get a six-month Medigap Open Enrollment Period. During that window, insurers can't turn you down or charge you more for health reasons. After that window closes, in most states, medical underwriting can apply if you try to buy or switch Medigap policies.

How prescription drugs work in each path

Drug coverage (Part D) is handled differently depending on your path.

• With Original Medicare + Medigap, you sign up for a stand-alone Part D drug plan.
• With Medicare Advantage, drug coverage is usually built into the plan (called an MA-PD).

Either way, the same program-level protections apply: the annual out-of-pocket cap on covered Part D drugs is $2,100 in 2026 and $2,400 in 2027, and the maximum deductible is $615 in 2026 and $700 in 2027. The old "donut hole" is gone, replaced by three simpler phases. If a big drug bill hits early in the year, the Medicare Prescription Payment Plan lets you spread those costs across monthly payments instead of paying all at once.

How to think it through

There's no universally right answer. A few honest questions can help point you in the right direction:

• Do you travel or split time between states? Original Medicare works anywhere in the U.S. that accepts Medicare. Advantage plans usually rely on local networks.
• Do you have preferred doctors or a specialist you want to keep? Check whether they accept Medicare (they likely do) and whether they're in the network of any Advantage plan you're considering.
• How do you feel about predictability vs. flexibility? Medigap generally means higher monthly premiums but very predictable bills at the doctor. Advantage often means lower premiums but copays and rules that vary by service.
• What's your health picture? If you expect a lot of care, the Medigap route's predictability appeals to some people. If you're generally healthy, an Advantage plan's bundled extras may matter more.
• Income matters too. If your income is above $109,000 as a single filer (2026), IRMAA surcharges are added to your Part B and Part D premiums, no matter which path you choose.

What's available around Iowa City

Iowa City is in Johnson County, where both paths are available: you can enroll in Original Medicare (with or without a Medigap policy and a stand-alone Part D plan), or you can choose from the Medicare Advantage plans offered in the county. Plan availability and carriers are set at the county level and can change each year, so the specific options in Johnson County may look different from those in a neighboring county.

You can compare what's offered locally using the plan finder at medicare.gov.

Key dates to remember

• October 15 – December 7: Annual Enrollment Period. You can join, switch, or drop a Medicare Advantage or Part D plan. Changes take effect January 1.
• January 1 – March 31: Medicare Advantage Open Enrollment. If you're already in an Advantage plan, you can switch to another Advantage plan or return to Original Medicare (and add a Part D plan).
• Your Medigap Open Enrollment Period: the six months starting when you're 65 and enrolled in Part B — the easiest time to buy a Medigap policy.