Medicare 2026

How Standardized Medigap Letters Work in Sanford

# Original Medicare with a Medigap plan vs. Medicare Advantage: how to think it…

SANFORD, Maine — If you're turning 65 in Sanford, or helping a parent sort through mail from insurance companies, you've probably run into the same fork in the road: stick with Original Medicare and add a Medigap policy, or go with a Medicare Advantage plan? Both are legitimate ways to get your Medicare coverage. They're just built very differently, and that structure — not the shiny brochures — is what shapes your care and your costs.

Here's a plain-English guide to the difference, and how Sanford residents can think it through.

Two different structures, not two versions of the same thing

Original Medicare is the federal program run directly by Medicare. It has two main parts: Part A (hospital) and Part B (doctors and outpatient care). You can go to almost 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 might owe out of pocket.

That's where a Medigap policy (also called Medicare Supplement Insurance) comes in. Medigap is sold by private insurers and is designed to pay some or all of the costs Original Medicare leaves behind. Because Original Medicare doesn't include drug coverage, people who choose this path usually also add a standalone Part D drug plan.

Medicare Advantage (Part C) is different. It's a private plan you choose instead of getting your benefits directly from Original Medicare. The insurer contracts with Medicare to provide your Part A and Part B care, usually through a network of doctors and hospitals, and most Advantage plans include Part D drug coverage built in. Many also bundle extras like dental, vision, hearing, or fitness benefits. In exchange, you generally follow the plan's network rules and may need referrals or prior approval for certain services.

So the real question isn't "which is better." It's "which structure fits my life?"

What each path tends to feel like day to day

With Original Medicare + Medigap + Part D, the appeal is predictability and freedom. You can see specialists without referrals, travel and use Medicare anywhere in the country, and — depending on which Medigap plan you buy — have very few surprise bills. The trade-off is that you're typically paying three monthly premiums (Part B, Medigap, and Part D), and Medigap premiums can rise over time.

With Medicare Advantage, the appeal is one-stop coverage, often with a lower monthly premium and extra benefits rolled in. The trade-off is the network — you'll want to check that your doctors, hospitals, and preferred pharmacies participate — and the fact that costs come in the form of copays and coinsurance as you use care, up to a yearly out-of-pocket maximum set by the plan.

Neither approach is inherently cheaper. It depends on your health, your prescriptions, how often you travel, and how much certainty you want in your budget.

What's available around Sanford

Sanford is in York County, where a range of Medicare Advantage and Part D plans are offered by multiple private insurers. Medicare plan availability is set at the county level, so two neighbors just across a town line can sometimes see slightly different options. You can see the current year's plans for your ZIP code using the Plan Finder at medicare.gov.

Medigap works differently. It's regulated by the state of Maine, and Maine has some of the more consumer-friendly Medigap rules in the country, including guaranteed-issue protections that go beyond the federal minimum. If you're considering Medigap, it's worth asking specifically about Maine's rules before you decide.

The 2027 numbers worth knowing

A few program-level figures apply no matter which path you choose:

• Part D out-of-pocket cap: $2,100 in 2026 and $2,400 in 2027. Once your out-of-pocket spending on covered drugs hits that amount, you pay $0 for covered drugs the rest of the year.
• Part D maximum deductible: $615 in 2026 and $700 in 2027 (plans may charge less).
• The old "donut hole" coverage gap is gone as of 2025. Part D now has three phases instead of four.
• Medicare Prescription Payment Plan: an optional program that lets you spread your drug costs across the calendar year in monthly payments instead of paying at the pharmacy counter.
• IRMAA: higher-income beneficiaries pay an added amount for Part B and Part D. For 2026, IRMAA surcharges start above $109,000 in income for a single filer (based on your 2024 tax return).

Deadlines to keep on your calendar

• Annual Enrollment Period: October 15 – December 7, 2026. This is when anyone with Medicare can join, switch, or drop a Medicare Advantage or Part D plan for 2027 coverage.
• Medicare Advantage Open Enrollment Period: January 1 – March 31. If you're already in an Advantage plan, you get one chance during this window to switch to a different Advantage plan or drop back to Original Medicare (and pick up a Part D plan).
• Your Medigap open enrollment window is a one-time, six-month period that starts when you're 65 and enrolled in Part B. During that window, insurers can't turn you down or charge you more based on your health. Outside of it, Medigap medical underwriting rules vary — another reason to check Maine's specific protections.

A simple way to decide

Try answering these questions before you compare specific plans:

1. Which doctors and hospitals do I want to keep? Call them and ask what they accept. 2. What prescriptions do I take? Their cost varies a lot from plan to plan. 3. Do I travel or spend part of the year out of state? Original Medicare travels easily; Advantage networks usually don't. 4. How much monthly premium am I comfortable with in exchange for fewer surprise bills later? 5. Do I want extras like dental and vision bundled in, or would I rather buy those separately?

Your answers usually point clearly toward one structure or the other.