Medicare 2026

Medicare coverage in Lewiston: two structural paths

LEWISTON, Maine — Choosing how to get your Medicare coverage can feel like standing at a fork in the road. One path keeps you on Original Medicare and lets you add a Medigap policy to help with the bills Medicare doesn't pay. The other path moves your coverage over to a private Medicare Advantage plan. Both are legitimate, both are common, and they work very differently.

Here's a plain-language look at how the two paths are built, so you can decide which shape of coverage fits your life.

Path one: Original Medicare plus Medigap

Original Medicare is the federal program most people picture when they hear "Medicare." It has two parts: Part A (hospital) and Part B (doctor and outpatient). You can see any doctor or hospital in the country that accepts Medicare, and you don't need referrals.

Original Medicare pays most of your care, but not all of it. There are deductibles, coinsurance, and no yearly cap on what you could owe out of pocket. That's where Medigap comes in.

A Medigap (also called Medicare Supplement) policy is sold by a private insurance company. It sits on top of Original Medicare and pays some or all of the costs Medicare leaves for you, depending on which lettered plan you buy. Medigap does not include drug coverage, so most people on this path also enroll in a standalone Part D drug plan.

Path two: Medicare Advantage

Medicare Advantage (Part C) is different. Instead of adding on to Original Medicare, you get your Part A and Part B benefits through a private plan approved by Medicare. The plan takes over the day-to-day job of paying your claims.

Advantage plans usually work through a network of doctors and hospitals — often an HMO or PPO — and may require referrals or prior approval for certain services. Many include prescription drug coverage and extras like dental, vision, or hearing benefits. Every Advantage plan is required to have a yearly out-of-pocket maximum for medical care.

Lewiston is in Androscoggin County, where the number of Medicare Advantage plans available changes each year. You can check current options for your ZIP code on medicare.gov.

How drug coverage fits in

Part D is the piece that pays for prescription drugs, and 2027 brings some notable program-level rules:

• The most you'll pay out of pocket for covered Part D drugs is capped at $2,400 for the year.
• The Part D deductible cannot be higher than $700.
• The old "donut hole" coverage gap is gone; Part D now has three phases.
• You can ask to spread your drug costs across the year through the Medicare Prescription Payment Plan.

If you go the Original Medicare + Medigap route, you'll typically buy a separate Part D plan. If you pick Medicare Advantage, drug coverage is usually baked in — but not always, so read carefully.

What about higher-income surcharges?

Some people pay more for Part B and Part D because of their income. These are called IRMAA surcharges, and in 2026 they begin above $109,000 in income for a single filer (higher for joint filers). IRMAA applies no matter which path you choose. Social Security notifies you if it affects you.

When you can make changes

Two windows matter most:

• Annual Enrollment Period: Oct. 15 – Dec. 7. You can join, switch, or drop a Medicare Advantage or Part D plan for coverage starting Jan. 1.
• Medicare Advantage Open Enrollment: Jan. 1 – March 31. If you're already in an Advantage plan, you get one chance to switch to another Advantage plan or return to Original Medicare (and add a Part D plan).

One important note on Medigap: the strongest time to buy a Medigap policy is your six-month Medigap Open Enrollment Period, which starts when you're 65 or older and enrolled in Part B. During that window, companies can't turn you down or charge more for health reasons. Outside of it, in most states, they can. That's a big reason the choice between paths deserves careful thought up front.

Which path is "right"?

There's no single answer. Some people value the freedom to see any Medicare-accepting provider and the predictability that Medigap adds. Others prefer the bundled feel of a Medicare Advantage plan, with medical, drug, and extra benefits under one roof and a yearly cap on medical spending.

Your health, the doctors you want to keep, your prescriptions, your budget, and whether you travel often all factor in. So does what's actually offered in Androscoggin County in a given year.