Medicare 2026

How Medicare and Medigap differ in Barnstable, Mass.

BARNSTABLE, Mass. — Every fall, people turning 65 on Cape Cod face the same fork in the road. Do you stay with Original Medicare and add a Medigap policy, or do you go with a Medicare Advantage plan? Both are legal, both are common, and both are very different in how they work. Understanding that difference is the single most important step in choosing coverage.

Path one: Original Medicare plus Medigap

Original Medicare is the federal program itself — Part A (hospital) and Part B (doctor and outpatient). You can see any provider in the country that accepts Medicare, and you don't need referrals.

But Original Medicare has no yearly out-of-pocket limit. That's where Medigap (also called Medicare Supplement Insurance) comes in. Sold by private insurers under standardized letter plans, Medigap helps cover the coinsurance, copays, and deductibles Original Medicare leaves you to pay. Drug coverage is separate — you'd add a standalone Part D plan.

Path two: Medicare Advantage

Medicare Advantage (Part C) is different. Instead of using Original Medicare directly, you get your Part A and Part B benefits through a private plan approved by Medicare. Most Advantage plans include Part D drug coverage, and many bundle in extras like vision, dental, or hearing.

The trade-off is structure. Advantage plans usually operate through networks (HMOs or PPOs), may require referrals or prior authorization, and have their own yearly out-of-pocket maximums that apply to medical services.

Barnstable's local picture

Barnstable is in Barnstable County, where Medicare plan availability is set. The number of Advantage plans and standalone Part D plans offered in the county changes each year, and carriers can adjust networks, formularies, and cost-sharing between plan years. That's why CMS urges every enrollee to review their coverage each fall, even if they're happy.

You can compare what's offered in Barnstable County using the Plan Finder at medicare.gov.

What's the same on both paths

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

• Part D has a $2,400 out-of-pocket cap on covered drugs.
• The Part D deductible cannot exceed $700.
• The old coverage gap (the "donut hole") is gone — Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the year in monthly amounts, at no extra charge.
• IRMAA surcharges on Part B and Part D begin above $109,000 in income for a single filer in 2026.

Enrollment windows to remember

• Oct. 15 – Dec. 7: Annual Enrollment Period. You can join, switch, or drop a Medicare Advantage or Part D plan.
• Jan. 1 – March 31: Medicare Advantage Open Enrollment. If you're already in an Advantage plan, you can switch once or return to Original Medicare.

One important note about Medigap: outside of your initial six-month Medigap Open Enrollment Period (which starts when you're 65 and enrolled in Part B), insurers in most states can use medical underwriting. Massachusetts has some of the strongest Medigap consumer protections in the country, so it's worth asking your SHIP counselor how the rules apply to your situation.