Medicare 2026

Medicare in Auburn, Maine: two structures compared

AUBURN, Maine — For people signing up for Medicare this fall, the biggest decision usually isn't which plan to pick. It's which path to take. Original Medicare paired with a Medigap policy works one way. Medicare Advantage works another. The two are built on very different frames, and understanding that structure is the key to picking what fits your life.

With the Annual Enrollment Period running now through Dec. 7, here is a plain-English look at how the two paths differ.

Path one: Original Medicare, often paired with Medigap

Original Medicare is the traditional, federally run program. It has two parts:

• Part A covers hospital stays, skilled nursing, hospice, and some home health.
• Part B covers doctor visits, outpatient care, preventive services, and durable medical equipment.

Original Medicare lets you see any doctor or hospital in the country that accepts Medicare — and most do. There are no networks and no referrals.

The trade-off is that Original Medicare doesn't cap what you pay out of pocket each year. That's where Medigap (also called Medicare Supplement Insurance) comes in. Medigap is a separate policy, sold by private insurers, that helps pay the deductibles, copays, and coinsurance Original Medicare leaves behind. Medigap plans are standardized by letter (Plan G, Plan N, and so on), so a Plan G from one company covers the same things as a Plan G from another.

Because Original Medicare doesn't include prescription drugs, most people on this path also add a stand-alone Part D plan for medications.

Path two: Medicare Advantage (Part C)

Medicare Advantage is a bundled alternative. Private insurers, approved by Medicare, deliver your Part A and Part B benefits — and usually Part D drug coverage — through a single plan. Many plans also include extras that Original Medicare doesn't cover, such as routine dental, vision, or hearing benefits.

Medicare Advantage plans typically use provider networks (HMOs and PPOs are the most common types). You may need to stay in-network, get referrals, or ask for prior approval for certain services. In exchange, these plans include an annual out-of-pocket maximum on Part A and Part B services, which Original Medicare alone does not have.

Auburn is in Androscoggin County, where Medicare Advantage plans are offered by several carriers. The specific plans available change every year, which is why the fall enrollment window matters.

The structural difference in one sentence

Original Medicare + Medigap spreads your coverage across separate pieces you assemble yourself, with wide provider access and predictable costs once Medigap is in place. Medicare Advantage bundles everything into one plan, often with extra benefits, in exchange for using a network and following the plan's rules.

Neither path is universally "better." The right fit depends on your doctors, your prescriptions, how often you travel, and how you feel about networks versus flexibility.

What's the same on both paths in 2027

No matter which path you choose, some 2027 Medicare rules apply across the board:

• The Part D out-of-pocket cap is $2,400 in 2027. Once you hit it, you pay $0 for covered drugs the rest of the year.
• The Part D maximum deductible is $700 in 2027.
• The old coverage gap ("donut hole") is gone — Part D now has three phases, not four.
• The Medicare Prescription Payment Plan lets you spread drug costs into level monthly payments instead of paying big amounts at the pharmacy counter.
• IRMAA surcharges — extra amounts higher earners pay for Part B and Part D — start above $109,000 in income for a single filer in 2026.

Key dates to circle

• Oct. 15 – Dec. 7: Annual Enrollment Period. You can switch between Original Medicare and Medicare Advantage, change Part D plans, or join a plan for the first time if you're already enrolled in Medicare.
• Jan. 1 – March 31: Medicare Advantage Open Enrollment Period. If you're already in a Medicare Advantage plan, you can switch to another one or return to Original Medicare (and add a Part D plan).

One thing worth knowing before you switch: moving from Medicare Advantage back to Original Medicare + Medigap later in life can be harder than it sounds. Outside of your initial Medigap open enrollment window, insurers in most states can use medical underwriting, meaning your health history can affect whether you can buy a Medigap policy or what it will cost. It's worth asking about before you decide.