Medicare 2026

Medicare Advantage or Original Medicare with Medigap in Dearborn Heights

In Dearborn Heights, turning 65 usually comes with a stack of mail and a big question: should you stick with Original Medicare and add a Medigap policy, or go with a Medicare Advantage plan? They sound similar. They work very differently. Understanding that difference up front can save you a lot of second-guessing later.

Two different roads, same starting point

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

On Path 1, you keep Original Medicare (Parts A and B), and you can add a Medigap policy to help with the deductibles and coinsurance Original Medicare doesn't cover. Because Medigap only fills gaps, you also typically add a stand-alone Part D plan for prescription drugs.

On Path 2, you choose a Medicare Advantage plan (Part C). This is a private plan that contracts with Medicare to deliver your Part A and Part B benefits, usually with extra features bundled in, and most include Part D drug coverage.

You generally can't mix the two: if you're on a Medicare Advantage plan, you can't also use a Medigap policy.

How Original Medicare + Medigap works

With Original Medicare, you can see any doctor or hospital in the country that accepts Medicare — and most do. There's no plan network to check.

Medicare pays its share, and you're responsible for the rest — the Part A hospital deductible, the 20% coinsurance under Part B, and so on. A Medigap policy is designed to pick up some or all of those out-of-pocket amounts, depending on which lettered plan (like Plan G or Plan N) you choose. Medigap policies are standardized, so a Plan G from one company covers the same things as a Plan G from another.

Because drug coverage isn't built in, you'd pair this setup with a stand-alone Part D plan.

How Medicare Advantage works

A Medicare Advantage plan takes over the delivery of your Part A and Part B benefits. You still have Medicare — you just get it through a private company that has to follow Medicare's rules.

These plans usually have networks (HMO or PPO), and many include extras Original Medicare doesn't cover, like routine dental, vision, hearing, or a fitness benefit. Costs work differently too: instead of a flat 20% coinsurance, you might see copays for specific services, and every Medicare Advantage plan has an annual out-of-pocket maximum for Part A and B services.

Dearborn Heights sits in Wayne County, where Medicare Advantage availability is set at the county level. That means the menu of plans a neighbor sees is the same one available across the county — not something unique to your ZIP code.

What's changing in 2027 for drug coverage

Whichever path you take, Part D rules apply to your drug coverage — either as a stand-alone plan or built into a Medicare Advantage plan.

For 2027:

• The out-of-pocket cap on Part D drugs is $2,400. Once you hit it, you pay $0 for covered drugs the rest of the year.
• The maximum Part D deductible is $700.
• The old "donut hole" coverage gap is gone as of 2025. Part D now has three phases instead of four.
• The Medicare Prescription Payment Plan lets you spread your drug costs into monthly payments across the year, if that helps your budget.

Higher-income enrollees may also pay an IRMAA surcharge on Part B and Part D premiums. In 2026, IRMAA starts above $109,000 in income for a single filer.

Key dates to circle

• 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 a Medicare Advantage plan, you get one chance to switch to a different Advantage plan or return to Original Medicare (and add a Part D plan).

One thing to know before you leap: while you can usually switch into Medicare Advantage freely, moving back to Original Medicare and buying a Medigap policy later can involve medical underwriting, depending on when you apply and your state's rules. That's worth asking about before you decide.

Getting straight answers in Dearborn Heights

Because the two paths work so differently — networks vs. no networks, monthly premiums vs. cost-sharing, bundled vs. separate drug coverage — the "right" choice really depends on your doctors, your medications, your travel habits, and your budget.

For unbiased help:

• Visit Medicare.gov to compare plans available in Wayne County using the Plan Finder.
• Call 1-800-MEDICARE (1-800-633-4227), 24/7.
• Contact Michigan's SHIP program, MMAP (Medicare/Medicaid Assistance Program) at 1-800-803-7174 for free, one-on-one counseling.