Medicare 2026

Before Dec. 7: The Medicare choice Warren retirees face

WARREN, Mich. — If you live in Warren and you're sorting through Medicare mail before the December 7 deadline, you are really being asked to make one big structural decision. It isn't about which plan has the shiniest brochure. It's about which system you want your health coverage to run through: Original Medicare paired with a Medigap policy, or Medicare Advantage.

These two paths are built differently, pay providers differently, and handle your out-of-pocket costs differently. Understanding that difference is the single most useful thing you can do this Annual Enrollment Period.

The two paths, in plain English

Path 1: Original Medicare + Medigap (+ usually a Part D drug plan). Original Medicare is the federal program — Part A (hospital) and Part B (doctor and outpatient). It pays most of your covered care, but leaves deductibles and coinsurance for you. A Medigap policy, sold by private insurers, helps pay those leftover costs. Because Original Medicare is nationwide, you can generally see any provider in the U.S. that accepts Medicare, with no network. You typically add a stand-alone Part D plan for prescriptions.

Path 2: Medicare Advantage (Part C). Medicare Advantage is a private plan that takes over how you receive your Part A and Part B benefits. Most Advantage plans also include Part D drug coverage and sometimes extras like dental or vision. In exchange, you usually agree to use the plan's network of doctors and hospitals, and to follow its rules — things like referrals or prior authorization for certain services.

You can't be enrolled in both a Medigap policy and a Medicare Advantage plan at the same time. They are two different ways to structure the same underlying Medicare entitlement.

How the money works

The two paths handle cost-sharing very differently.

With Original Medicare + Medigap, you generally pay a Part B premium, a Medigap premium, and (if you add one) a Part D premium. In return, most of your per-visit costs are predictable, because the Medigap policy is picking up much of what Medicare doesn't.

With Medicare Advantage, premiums can be lower, but you pay copays or coinsurance as you use services, up to the plan's annual out-of-pocket maximum. Advantage plans are required to cap your yearly in-network medical spending; Original Medicare by itself does not have that cap, which is a big reason people pair it with Medigap.

Either way, Part D drug coverage has its own rules that apply across the board. The maximum deductible is $615 in 2026 and $700 in 2027. The annual out-of-pocket cap on covered drugs is $2,100 in 2026 and $2,400 in 2027, and there is no coverage gap (the "donut hole" was eliminated in 2025). If those drug costs would land hard in one month, the Medicare Prescription Payment Plan lets you spread them across the year.

Access to doctors and hospitals

This is where the paths feel most different day to day.

Original Medicare's network is essentially every provider in the country that accepts Medicare — and most do. If you split time between Michigan and another state, or you want to see a specialist at a hospital system outside your area, that flexibility matters.

Medicare Advantage plans are usually HMOs or PPOs with defined networks. Warren is in Macomb County, where multiple carriers offer Advantage plans, and the specific hospitals and doctors in-network can differ from one plan to the next. If you already have doctors you want to keep, checking each plan's provider directory is essential.

When you can switch — and when Medigap gets tricky

The Annual Enrollment Period (Oct. 15 – Dec. 7) is the main window to join, drop, or change a Medicare Advantage or Part D plan for the coming year. During Medicare Advantage Open Enrollment (Jan. 1 – March 31), people already in an Advantage plan can switch to a different Advantage plan or return to Original Medicare.

Here's the part that surprises people: moving back to Original Medicare is straightforward, but qualifying for a Medigap policy after your initial enrollment window may require answering health questions, and you can be turned down or charged more depending on your health and your state's rules. That's why the structural choice you make when you first go on Medicare deserves careful thought — it isn't always easy to undo years later.

A quick word on income and premiums

If your income is above $109,000 as a single filer in 2026 (higher for joint filers), you may pay an IRMAA surcharge on top of your standard Part B and Part D premiums. This applies whether you're in Original Medicare or Medicare Advantage — it's tied to your income, not your path.

How to think it through

Ask yourself, in this order:

1. Do I want to keep specific doctors or hospitals? Check whether they take Original Medicare and whether they're in the networks of Advantage plans you're considering. 2. How do I feel about predictable premiums vs. pay-as-you-go copays? Medigap trades a higher monthly premium for fewer surprises. Advantage often flips that. 3. Do I travel or split time between states? Original Medicare travels more easily. 4. What drugs am I on? Compare Part D coverage — either stand-alone or built into an Advantage plan — using the Plan Finder at medicare.gov. 5. Am I comfortable with prior authorization and referrals? These are more common in Advantage plans.

There is no universally right answer. There is a right answer for your health, your budget, and your life.